Welcome to Fidelity National Title -Napa County

TITLE AND ESCROW SERVICES

* Required Fields

USER INFORMATION

Date:	02/06/2012
Sales Representative:
*First Name:
Middle Name:
*Last Name:
*Email:
*Office Name:
*Office Address:
Office Address 2:
*City:
*State:
*Zip Code:
*Phone:	( ) - ext
Fax:	( ) - ext
Cell Phone:	( ) -

ORDER INFORMATION

*Services Requested:
*Transaction Type:
Estimated Close Date:	(Click to select date).
Transaction Amount:
*Property Type:	Other: (Required if Other is selected)
*Address1:
Address2:
*City:
*State:
*Zip Code:
*County:
APN:
Limited Coverage Policy:
Your Escrow Officer:
*Escrow Office:

PRINCIPALS

Seller First Name:
Seller Last Name:
Seller SSN *:
Co-Seller First Name:
Co-Seller Last Name:
Co-Seller SSN *:
Buyer First Name:
Buyer Last Name:
Buyer SSN *:
Co-Buyer First Name:
Co-Buyer Last Name:
Co-Buyer SSN *:

LISTING AGENT

First Name:
Last Name:
Company:
Address: *
City:
State: *
Zip Code:

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

SELLING AGENT

First Name:
Last Name:
Company:
Address: *
City:
State: *
Zip Code:

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

LENDER 1

First Name:
Last Name:
Mortgage Broker:
Company:
Address: *
City:
State: *
Zip Code:

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

LOAN DETAILS - LENDER 1

Existing Loan:
Account Number:
Loan Amount:

LENDER 2

First Name:
Last Name:
Mortgage Broker:
Company:
Address: *
City:
State: *
Zip Code:

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

LOAN DETAILS - LENDER 2

Existing Loan:
Account Number:
Loan Amount:

Special Instructions

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.

*Your FNTIC representative will contact you directly for this information.