Order Request Form Lender

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

REFINANCE- PLEASE INCLUDE THE 1003 APPLICATION
PURCHASE - please include purchase contract, addendum and general information release form for mortgage payoffs (include Soc.Sec.# for primary borrower)

Date:

REQUESTED BY:

COMPANY :

ADDRESS :

Fax Number/Contact Numbers for you:

Email Address:

SELLER:

Married (Husband & Wife)/Other Single

Home Phone # Work #s

Cell Phone #

PROPERTY ADDRESS:

County:

BUYER/BORROWER:

Home Phone # Work #s

Cell Phone # Married Single

LOAN AMOUNT: PURCHASE PRICE:

ESTIMATED CLOSING DATE:

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.