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Print and Fax to (502) 315-1519

Date ordered:___________________ Broker:____________________________

Contact Person:_________________ Phone:____________________________

Lender:________________________ Loan amount: $_____________________

Property address:__________________________________________________

City:________________ State:_______ County:_______________ Zip:_______

Borrowers name(s):_________________________________________________

Marital Status:__________________ Was property inherited?_______________

SS#:________-________-________(his) _________-________-_________(hers)

Is the home a manufactured home or trailer?_____________________________

Seller’s name(s):___________________________________________________

Marital Status:__________________ Was property inherited?_______________

SS#:________-________-________(his) _________-________-_________(hers)

(If a purchase, fax copy of Purchase Agreement or Contract for Deed)

Special Instructions:  Check or complete all applicable

If Secured Title to order payoffs, please list lender(s), phone & account number

__________________________________________________________________

__________________________________________________________________

POA or Trust:_____ Contract for Deed:______ Estate/Deceased spouse:______

Bankruptcy:_______ Foreclosure:_______ Other Instructions:_______________

__________________________________________________________________

 

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