Order Submitted By:

E-mail Address:

Listing Agency:		Agent:		Phone:
Selling Agency:		Agent:		Phone:

Date:

Closing Date Requested:

Buyer(s) Name:
Seller(s) Name:

Property Address / Legal:

Buyer's Loan Company:

Existing Mortgage(s) At:

Name of Loan Company:

Address:

City:

State:

Zip:

Phone:

Loan Number:

Existing Mortgage(s) At:

Name of Loan Company:

Address:

City:

State:

Zip:

Phone:

Loan Number:

Known Title Problems:

Termite Certificate Information:

Abstract / Prior Title Policy Information (Where)

Abstract Update

YES

NO

Owners Policy

YES

NO

Insurance Information:

Order Survey From:

Commission Rate:

Amount to Other Broker:

Buyer(s) Will Be At Closing

Yes

No

Seller(s) Will Be at the Closing

Yes

No

IF NOT PLEASE PROVIDE BUYERS / SELLERS ADDRESS FOR FEDERAL EXPRESSING PAPERS ($50 CHARGE)

Buyer(s) Name:

Address:

City:

State:

Zip:

Phone:

Seller(s) Name :

Address:

City:

State:

Zip:

Phone:

Power of Attorney Information:

Other Pertinent Information:

NOTE: Copies of the Offer and Acceptance must be faxed or sent
in an e-mailed attachment separate from this transaction.
Make e-mail attachments in a .jpg format.