Welcome to Fidelity National Title

TITLE AND ESCROW SERVICES

*Required Fields

ORDER INFORMATION - TO BE COMPLETED BY ORDERING PARTY

Name:	*
Services Requested:	*
Policy Type Requested:	*
Transaction Type:	*
Your Escrow Officer:	*
Your Sales Representative:	*
Your Title Officer:
Your Email Address:	*
Ordering Party Is:	*	If Other, please describe:
Reference #:
Special Instructions:

SELLER INFORMATION

Name - (1):
Name - (2):
Address:
City:
State:
Zip:

Phone:	( ) - ext
Fax:	( ) - ext
Pager:	( ) -
Cell Phone:	( ) -

BUYER INFORMATION

Name - (1):
Name - (2):
Address:
City:
State:
Zip:

Phone:	( ) - ext
Fax:	( ) - ext
Pager:	( ) -
Cell Phone:	( ) -

LISTING BROKER INFORMATION

Company:
Agent:
Email Address:
Address:
City:
State:
Zip:

Phone:	( ) - ext
Fax:	( ) - ext
Cell Phone:	( ) -
Pager:	( ) -

LISTING SELLER INFORMATION

Company:
Agent:
Email Address:
Address:
City:
State:
Zip:

Phone:	( ) - ext
Fax:	( ) - ext
Cell Phone:	( ) -
Pager:	( ) -

NEW LENDER INFORMATION

Company:
Loan Officer:
Email Address:
Address:
City:
State:
Zip:

Phone:	( ) - ext
Fax:	( ) - ext
Cell Phone:	( ) -
Pager:	( ) -
Mortgage Broker:

TRANSACTION INFORMATION

Sale Amount:
Loan Amount:
Close Of Escrow:	(mm/dd/yyyy)
Loan Type:	If Other, please describe:
Loan Position:	If Other, please describe:

PAYOFF INFORMATION

Payoff Lender's Loan #:
Payoff Lender's Amount:
Payoff Lender's Name:
Payoff Lender's Address:
Payoff Lender's City:
Payoff Lender's State:
Payoff Lender's Zip:

Payoff Lender's Phone:	( ) - ext
Payoff Lender's Fax:	( ) - ext
Payoff Lender's Cell Phone:	( ) -
Payoff Lender's Pager:	( ) -

SUBJECT PROPERTY INFORMATION

Property Type:	If Other, please describe:
Address:
City:
State:
Zip:
County:

MAILING ADDRESS (Complete only if different from subject property address)

Address:
City:
State:
Zip:

LEGAL DESCRIPTION

Lot:
Block:
Tract:
Map Book:
Page:
Tax/APN:
Full Legal Description:

Disclaimer: This site is not designed for the transmission of highly confidential customer, non-public personal information, and should therefore not be used to enter or transmit data such as customer Social Security Numbers or Driver's License Numbers.