Welcome to Fidelity National Title

TITLE AND ESCROW SERVICES

* Required Fields

YOUR INFORMATION

* Ordering Party:	Other: (Required if Other is selected)
Company Name:
Address:
City:
State:
Zip:
Phone:	( ) - ext
Fax:	( ) - ext
Cell Phone:	( ) -
*Contact Name:
*Email Address:
Reference #:

SELECT SERVICES

*Services Requested:
*Policy Type Requested:
Date:	02/08/2012
Your Escrow Officer:

SUBJECT PROPERTY AND SELLER INFO
Seller's Name:
Seller's Phone:	( ) - ext
Property Type:	Other: (Required if Other is selected)
Address:
City:
State:
Zip:
MAILING ADDRESS(Complete only if different from subject Property Address)
Address:
City:
State:
Zip:

TRANSACTION INFORMATION

*Transaction Type:
Sale Amount:
Loan Amount:
Loan Type:	Other: (Required if Other is selected)
Deposit with Contract:
Estimated Close Date: (MM/DD/YYYY)	(Click to select date).
Total Commission Amount:
T&E Fees Paid By:

BUYER INFORMATION

Name:
Address:
City:
State:
Zip:

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

BORROWER INFORMATION (Complete only if different than Buyer Information)

Name:
Address:
City:
State:
Zip:

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

PAYOFF INFORMATION

Lender’s Name:
Loan #:
Payoff Amount:

SELLER CARRYBACK TERMS

Note Amount:
Interest Rate:	%
Date all Due and Payable: (MM/dd/yyyy)	(Click to select date).
Payment Amount:
Late Charge:
Amortized Over:
Due on Sale Clause?
Prepayment Penalty:

DELIVERY INSTRUCTIONS

Delivery/Mail - LISTING AGENT

#Pre's:
CC&R:
Listing Agent:
Attention:
Other:
Address:
City:
State:
Zip:

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

Delivery/Mail - SELLING AGENT

#Pre's:
CC&R:
Selling Agent:
Attention:
Other:
Address:
City:
State:
Zip:

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

Delivery/Mail – NEW LENDER

#Pre's:
CC&R:
New Lender:
Attention:
Other:
Address:
City:
State:
Zip:

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

LEGAL DESCRIPTION

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

MISCELLANEOUS ITEMS REQUIRED

Termite Company:
Pest Report Paid by:
Pest Work Paid by:	Max Amount:
Septic Inspection Required:	Paid by: Max Amount:
Roof Inspection Required:	Paid by: Max Amount:
Home Warranty Inspection Required:	Paid by: Max Amount:
HOA:	Name:
Water Company:	Name:
District Name:
Prorations:	Taxes HOD Water Rents Other (Required if Other is selected)
Escrow Contingencies:

SPECIAL INSTRUCTIONS

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.