Order Title from Origin Title & Escrow, John C. Bennett Attorney

Mortgagee / Lender Information

Your Name*

FirstLast

Your Company Name

Your Company Address

Street AddressAddress Line 2CityStateZip Code

Your Phone

999-999-9999

Your Email Address*

Mortgagee / Lender Name

Lender ID

Use Address based on Lender ID

Yes

Mortgagee / Lender Address

Street AddressAddress Line 2CityStateZip Code

Lender Case Number

FHA Case Number

Property & Mortgage Information

Occupancy Status*

Primary Residence
Second Home
Investment Property

Loan Status*

Purchase
Cash-Out Refi
No Cash-Out Refi
Reverse Mortage

Sales Price

Loan Amount

Property Address

Street AddressAddress Line 2CityStateZip Code

County

Legal Description

Property Type

Borrower / Buyer Information

Name

FirstLast

Address

Street AddressAddress Line 2CityStateZip Code

Phone

999-999-9999

Email Address

Seller Information

Name

FirstLast

Last 4 Digits Seller's SSN

Phone

999-999-9999

Forwarding Address

Street AddressAddress Line 2CityStateZip Code

Listing Agent Name

FirstLast

Company

Phone

Fax

Email

Selling Agent Name

FirstLast

Company

Phone

Fax

Email

Payoffs

Loan officer, Process or Lender will order payoffs
Please order payoffs (loan information is below)

Lender One

Loan Account Number

Lender Two

Loan Account Number

Last 4 Digits Borrower's SSN

Title Commitment Information

Type of Policy

Estimated Closing Date

Mail Away

Yes
No

Special instructions

Prior Title Policy

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Sales Contract

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Deed/Misc. Docs

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