Order Request Form Realtor

TO: ESQUIRE TITLE SERVICES, INC.
6648 Walnut Street, New Albany, OH 43054
Phone: 614-855-96000 Fax: 614-855-6870

PURCHASE -please include purchase contract, addendum(s) and general information release form for mortgage payoffs (include Social Security Number for primary borrower)

Order Date:

REQUESTED BY:

Contact numbers for you:

SELLER:

Married (Husband & Wife)/Other Single

Home Phone # Work #s

Cell Phone #

Email Addresses:

PROPERTY ADDRESS:

County:

BUYER/BORROWER:

Married (Husband & Wife)/Other Single

Home Phone # Work #s

Cell Phone #

CO-OP AGENT COMPANY:

Office Phone: Cell Phone: Fax:

COMMISSION SPLIT: TOTAL % % Listing Agent % Selling Agent

LENDER:

CONTACT NAME:

Phone # Fax #

LOAN AMOUNT: PURCHASE PRICE:

ESTIMATED CLOSING DATE:

SPECIAL INSTRUCTIONS:

PAYOFF INFORMATION FOR EXISTING MORTGAGES:

1ST MORTGAGE:

Account #

Customer Service #

2nd MORTGAGE/EQUITY LINE OF CREDIT :

Account #

Customer Service #

Is there back title on the property? If the sellers/owners obtained owner’s title insurance less than 10 years ago we are able to give a discount of 30% on the new owner’s title insurance policy when a copy of Schedule A and Schedule B from the OWNERS TITLE INSURANCE POLICY is provided to us.