If you prefer to fax this form, CLICK HERE TO DOWNLOAD and fax it to
(305) 374-8987.

A. Order Information:  Required Field *
1. Your Name: *
2. Company Name:
3. Email Address: *
4. Contact #: *
5. FAX #:
B. Property Information:
1. Street Address: *
2. City: *
3. State: * ZIP Code: *
4. County:
5. Parcel ID #:
6. Full Legal Description:
C. Buyer / Borrower Information:
1. Name of Borrower: *
2. Name of Co-Borrower:
3. Marital Status: *
4. Borrower's Address: *
5. City: *
6. State: *
7. ZIP Code:
 *
8. Borrower's Contact #: *
9. Occupancy Status: *
10. Buyer's REALTORŪ Name:
Contact #:
 *
11. Escrow Deposit Held By:
Amount:
 *
D. Loan / Lender Information:
1. Purpose of This Loan: *
2. Purchase Price:
3. Loan Amount: *
4. Name of Proposed Lender: *
5. Loan Officer's Name:
6. Contact #: *
7. Estimated Closing Date:
E. Seller Information:   Leave this Section Blank if this is a Refinance Transaction
1. Name of Seller:
2. Name of Co-Seller:
3. Marital Status:
4. Seller's Address:
5. City:
6. State:
7. ZIP Code: *
8. Seller's Contact #:
9. Seller's REALTORŪ Name:
10. Contact #: *
F. Additional Information:
1. First Mortgage Holder:
Loan #:
 *
2. Name of Contact:
Contact #:
 *
3. Second Mortgage Holder:
Loan #:
 *
4. Name of Contact:
Contact #:
 *
5. Does a Survey need to be ordered for the Property?YES NO
6. Does a Termite Inspection need to be ordered?YES NO
7. Is there a Homeowner's and/or Condo Association? YES NO
8. If YES, Name of Contact:
Contact #:
 *
9. Hazard Insurance Company:
10. Name of Contact:
Contact #:
 *
11. Additional Comments:
 

 

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66 West Flagler Street, 9th Floor, Miami, FL 33131
Phone (305) 374-8984 Fax (305) 374-8987
Email info@bankerstitleservices.com