TITLE ORDER FORM
= Required
Company:		Date Ordered:
Ordered By:		Phone #:
Return Fax #:		Needed By:
Return E-mail:
Property Address:
Brief Legal Description:
Parcel ID:		County:
Purchaser/Borrower(s):		SSN #:
Additiona Borrower		SSN #:
Home/Cell#:		Work #:
Seller:		SSN #:
Additional Seller:		SSN #:
Home/Cell:		Work #:
MORTGAGE INFORMATION
New Financing:		Current Mortgage(s) To Payoff:
Sales Price:		Lender(1):
Loan Amount:		Account #:
Lender Name:		Phone #:
Contact:		Lender(2):
Phone:		Account #:
E-mail:		Phone #:
*If you are requesting Regency Title & Closing, LLC to order payoffs of mortgages please provide a signed authorization form with SSN along with the mortgage account numbers. This will ensure that there are no delays at closing.
CLOSING INFORMATION
Estimated Closing Date:		Will Regency Title be closing this loan?	Yes No
If not please provide the following:
Attorney/Firm:		Contact:
Address:		Phone #:
Fax #:
Special Instructions: