Welcome to Fidelity National Title

TITLE AND ESCROW SERVICES

*Required Fields

SUBJECT PROPERTY AND SELLER INFO

Seller Name:
Seller 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

Services Requested:
Your Escrow Officer: *
Date:	(mm/dd/yyyy)

DELIVERY INSTRUCTIONS

Deliver/Mail Listing Agent
#Pre's:
CC&R:
Listing Agent:
Phone :	() - ext
Attention:
Other:
Address:
City :
State:
Zip:

Deliver/Mail Selling Agent
#Pre's:
CC&R:
Selling Agent:
Phone :	() - ext
Attention:
Other:
Address:
City :
State:
Zip:
Deliver/Mail New Lender
#Pre's:
CC&R :
New Lender:
Phone :	() - ext
Attention :
Other :
Address :
City :
State:
Zip:

YOUR INFORMATION

Ordering Party:	If Other, please describe:
Company:
Address:
City:
State:
Zip:
Phone:	( ) - ext
Fax:	( ) - ext
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

Name - (1):
Address:
City:
State:
Zip:

Phone:	( ) - ext
Fax:	( ) - ext
Pager:	( ) -
Cell Phone:	( ) -

Name - (2):
Address:
City:
State:
Zip:

Phone:	( ) - ext
Fax:	( ) - ext
Pager:	( ) -
Cell Phone:	( ) -

PAYOFF INFORMATION

Lender's Name:
Loan #:
Payoff Amount:

SELLER CARRYBACK TERMS

Note Amount:
Interest Rate:	%
Date All Due And Payable:	(mm/dd/yyyy)
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
Taxes
HOD
Water
Rents
Other
Escrow Contingencies:

SPECIAL INSTRUCTIONS

YOUR FIDELITY SALES REPRESENTATIVE

Please Identify
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.