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Today's
Date: |
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Date
Required: |
| Anticipated
Closing Date: |
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Services Requested: |
| Title Insurance/Purchase |
Purchase:
$ |
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| Title
Insurance/Refinance |
1st
Mortgage/
Refinance: $ |
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| Title
Insurance/Second Mortgage |
2nd
Mortgage: $ |
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| Foreclosure Search |
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| Informational Search |
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|
Applicant: |
| Name: |
|
Firm/Company: |
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| Street: |
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Email
Address: |
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| City: |
|
Phone: |
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| State: |
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Fax: |
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| Zip: |
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| Property Information: |
| Street: |
|
Condo: |
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| City: |
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Unit: |
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| State: |
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Building: |
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| Zip: |
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County: |
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| Block: |
|
Lot: |
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| Mailing
address if different then above |
| Street: |
|
State: |
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| City: |
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Zip: |
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Borrower/Buyer Information: |
| Borrower's
Name: |
|
Maiden
Name: |
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| SS#: |
|
Marital
Status: |
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| DL#: |
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| Co-Borrower's
Name: |
|
Maiden
Name: |
|
| SS#: |
|
Marital
Status: |
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| DL#: |
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| E-Mail
Address: |
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| Home
Phone #: |
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Work
Phone #: |
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|
Seller Information: |
| Seller's
Name: |
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|
|
| SS#: |
|
Maiden
Name: |
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| Seller's
Name: |
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| SS#: |
|
Maiden
Name: |
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| Seller's
Name: |
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| SS#: |
|
Maiden
Name: |
|
|
Lender Information: |
| Mortgage
Company: |
|
Street: |
|
| Contact: |
|
City: |
|
| Phone
#: |
|
State: |
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| Fax
#: |
|
Zip: |
|
|
Bank Review Attorney: (if applicable) |
| Name: |
|
Street: |
|
| Firm: |
|
City: |
|
| Phone
#: |
|
State: |
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| Fax
#: |
|
Zip: |
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|
Closing: |
|
Apex Title Agency, Inc.
to close |
|
| Closing Attorney,
if different from applicant please inform as to: |
| Name: |
|
Street: |
|
| Firm: |
|
City: |
|
| Phone
#: |
|
State: |
|
| Fax
#: |
|
Zip: |
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| Current Mortgage Information: (refinance only) |
| Primary
Bank/Lender |
|
| Name: |
|
Street: |
|
| Phone
#: |
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City: |
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| Account
#: |
|
State: |
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| Loan
Amount: |
|
Zip: |
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| Second
Mortgage/Home Equity Line |
|
| Name: |
|
Street: |
|
| Phone
#: |
|
City: |
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| Account
#: |
|
State: |
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| Loan
Amount: |
|
Zip: |
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| Homeowners Insurance Information: |
| The
lender will require a copy of your homeowners insurance declaration page and a paid
receipt. Please provide us with the following information: |
| Insurance
Agency Name: |
|
Phone
#: |
|
| Policy
#: |
|
|
|
Back Title Information: (select one) |
Apex Title Agency, Inc.
previously insured as File #: AT
Another
title company previously insured, please fax copy to (732) 868-6955
None |
|
Survey Information: (select one) |
|
Apex
Title to order new survey |
|
Applicant to
provide |
|
Use existing survey with Affidavit of No Change |
|
Use
No Survey Survey Endorsement |
| Not Required |
|
Additional Services |
|
Flood Certification |
|
| Prepare Notice of Settlement |
|
| File Notice of Settlement |
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| Order Mortgage Payoffs |
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|
|
| Other
Special Requirements/Comments |
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