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Your Info
Date of Request:
1. Processor
Phone
2. Loan Officer
Fax
3. Loan Officer's Manager's Name
Cell
4. Company Name
Email
Borrower Info
Borrower 1
Borrower 2
First Name
Middle Name
Last Name
Relationship
Select
Husband
Wife
Son
Daughter
Mother
Father
Brother
Sister
Other
Social Security No.
Home Phone No.
First Name
Middle Name
Last Name
Relationship
Select
Husband
Wife
Son
Daughter
Mother
Father
Brother
Sister
Other
Social Security No.
Work Phone No.
Property Address:
Address Line 1:
Address Line 2:
City, State Zip
County
Please choose one:
Primary Residence
Investment Property
Second Home
Lender Info
Lender
Phone
Lender Add
Loan Amount (no comma):
$
Lien Position:
1st
2nd
3rd
PURCHASE
REFINANCE
Mortgage Type
FHA
FHA Streamline
VA
VA Streamline
Conv Uninsured
Conv Insured
HECM (Reverse Mtg)
DOES THE LENDER REQUIRE A SURVEY?
Yes
No
Affidavit
ESTIMATED CLOSING DATE:
Lien Info
Open Mortgages
---
0
1
2
3
4
5
6
7
8
9
MTG/DOT #1
MTG/DOT #2:
Lender
Acct. No.
Unpaid Bal.
Lender
Acct. No.
Unpaid Bal.
Independence Title, Inc. to order payoffs?
NO
YES
Comments
Attach a document:
Please send my order confirmation to my:
Email Address
Fax Number
When ordering title work, please provide a copy of the following:
1. A copy of the loan application for refinances.
2. Authorization to release information.
3. Purchase, a complete copy of the contract of sale
4. Owners Title Insurance Policy for a reissue rate
Once you click
you will receive an email or fax confirmation with the file number assigned to this transaction. For the ease of accurate communication, please feel free to reference this file number.
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