Welcome to Fidelity National Title

TITLE AND ESCROW SERVICES

* Required Fields

SUBJECT PROPERTY AND SELLER INFO

Seller's Name:
Seller's Phone:	( ) - ext
Property Type:	If Other, please describe:
Subject property: *
City:
State:*
Zip:

MAILING ADDRESS(Complete only if different from Subject Property Address)

Address:*
City:
State:*
Zip:

LEGAL DESCRIPTION

Lot:
Block:
Tract:
Map Book:
Page:
Tax/APN:
Full Legal Description:

SELECT SERVICES

Service Type:	*
Date:
Your Escrow Officer:

DELIVERY INSTRUCTIONS

Deliver/Mail - Listing Agent:

#Pre's:
CC&R:
Listing Agent Company:
Phone:	( ) - ext
Agent Name:
Other:
Address: *
City:
State:*
Zip:

Deliver/Mail - Selling Agent:

#Pre's:
CC&R:
Selling Agent Company:
Phone:	( ) - ext
Agent Name:
Other:
Address:*
City:
State:*
Zip:

Deliver/Mail - New Lender:

#Pre's:
CC&R:
New Lender Company:
Phone:	( ) - ext
Agent Name:
Other:
Address:*
City:
State:*
Zip:

YOUR INFORMATION

Ordering Party Is:	* If Other, please describe:
Company Name:
Address: *
City:
State:*
Zip:
Phone #:	( ) - ext
Fax #:	( ) -
Contact Name:	*
Email Address:	*
Reference #:

TRANSACTION INFORMATION

Trans. Type:
Sale Amount:
Loan Amount:
Loan Type:	If Other, please describe:
Deposit with contract:
Estimated COE:
Total Commission Amount:
T&E Fees paid by:

BUYER/BORROWER INFORMATION

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

PAYOFF INFORMATION

Lender's Name:
Loan #:
Payoff Amount:

SELLER CARRYBACK TERMS

Note Amount:
Interest Rate:
Date all Due and Payable:
Payment Amount:
Late Charge:
Amortized Over:
Due on Sale Clause?
Prepayment Penalty:

MISCELLANEOUS ITEMS REQUIRED

Termite Company:
Pest Report Paid by:
Pest Work Paid by:	Max Amount:
Septic Inspection Required:	Paid by: Max Amount:
Roof Inspection Required:	Paid by: Max Amount:
Home Warranty Inspection Required:	Paid by: Max Amount:
HOA:	Name:
Water Company:	Name:
District Name:
Prorations:	HODRentsTaxesWaterOther If Other,please describe
Escrow Contingencies:

SPECIAL INSTRUCTIONS

Special Instructions:
Your Fidelity Sales Representative:	*

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.