Loan Officer/Lender (* Required) *Company: Branch: *Contact: First Name: Last Name: Address: City: State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip: *Email:   *Phone: Fax:

Type of Search:	Last Deed Search 15 yr Search 16-25 yr Search Name/Lien Search Mineral Search Title Opinion
Tax Certificate:	Yes No
Type of Loan:	Home Equity Refinance Purchase Commercial
Property Type:	Residential  Land  Commercial
Property Information:
*Legal Description: 4 lines or less
Address:
Parcel Number:
City:
State:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY    Zip:
County:
Borrowers
Borrower 1: First:	Middle:  Last:
Borrower 2: First:	Middle:  Last:
Current Owner(s) if different
Owner 1: First:	Middle:  Last:
Owner 2: First:	Middle:  Last:
Anticipated Closing Date:
Additional Comments: