Welcome to Fidelity National Title

REFI TITLE AND ESCROW SERVICES

* Required Fields

YOUR INFORMATION

Name:	*
Email Address:	*
Service Requested:	*
Policy Type Requested:	*
Your Escrow Officer:
Your Title Officer:
Ordering Party Is:	* If Other, please describe:

BORROWER INFORMATION

Borrower:
Co-Borrower:
Address: *
City:
State: *
Zip:
Phone:	( ) - ext
Fax:	( ) - ext

LENDER INFORMATION

Company:
Loan Officer:
Email Address:
Address: *
City:
State: *
Zip:
Phone:	( ) - ext
Fax:	( ) - ext
Cell Phone:	( ) -
Pager:	( ) -
Mortgage Broker:

TRANSACTION INFORMATION

Refinanced Loan Amount:
Loan Type:	If Other, please describe:
Loan Position:	If Other, please describe:

PAYOFF INFORMATION

Payoff Loan #:
Payoff Amount:
Payoff Lender's Name:
Payoff Lender's Address:*
Payoff Lender's City:
Payoff Lender's State:*
Payoff Lender's Zip:
Lender's Phone:	( ) - ext
Fax:	( ) - ext
Cell Phone:	( ) -
Pager:	( ) -

SECOND PAYOFF INFORMATION

Payoff Loan #:
Payoff Amount:
Payoff Lender's Name:
Payoff Lender's Address:*
Payoff Lender's City:
Payoff Lender's State:*
Payoff Lender's Zip:
Lender's Phone:	( ) - ext
Fax:	( ) - ext
Cell Phone:	( ) -
Pager:	( ) -

SUBJECT PROPERTY INFORMATION

Property Type:	If Other, please describe:
Address:*
City:
State:*
Zip:
County:

MAILING ADDRESS(Complete only if different from subject property address)

Address:*
City:
State:*
Zip:

SPECIAL INSTRUCTIONS

Your Fidelity Sales Representative:	*
Special Instructions:

Disclaimer: This site is not designed for the transmission of highly confidential customer, non-public personal information, and should therefore not be used to enter or transmit data such as customer Social Security Numbers or Driver's License Numbers.