Executive Settlement Providers

For Realtors

Title Transaction Order Form

Executive Settlement Providers makes it easy for you to order Title on Purchases. Realtors, please fill out the form below for any transaction you want to order title on. An order Confirmation will be sent to the person whose information is entered here.

Your Name*:
Your Phone #*:
Your Email*:
Buyer/Seller Information
Buyer Name*:
Buyer Email*:
Buyer Cell Number:
Co-Buyer Name:
Buyer Phone #:
Home*:
Work:
Tenancy Will be Held by Buyer:	Tenants in Common Tenants by the Entirety Individually (One Owner)
Seller Name*:
Seller Email*:
Seller Cell Phone Number:
Co-Seller Name:
Seller Telephone:
Home*:
Work:
Property Information
Property Address*:
City*:
State:
County/Township:
Zip:
Parcel/Folio #:
Tax ID:
Lender Information
Lender Name*:
Lender Contact*:
Phone*:
Loan Amount*:
Realtor Information
Seller's Real Estate Agent*:
Phone*:
Buyer's Real Estate Agent*:
Phone*:
Payoff Information
Current First Mortgage Lender:
Loan / Account #:
Lender Phone #:
Current Equity / Second Mortgage Lender:
Loan / Account #:
Lender Phone #:
Notes or Special Instructions:

Authorization for Payoff Release Form