Order Request Form Realtor Contact Us! Call: (614) 855 – 9600 Email: info@esquiretitle.com Visit: 6648 Walnut Street, New Albany, OH 43054 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. Get In Touch Call: (614) 855-9600 Get an Online Quote Name Email Address Message 5 + 13 = Submit