Place an Order

Please complete fields appropriate to your order. Do not press ENTER until the end - use TAB to advance to next field.

YOUR INFORMATION

Ordering Party:

Company Name:

Address:

City:

State: Zip:

Phone #:

Ext:

Fax #:

Cell:

Client Name:

Email Address:

PLEASE IDENTIFY YOUR FIDELITY CONTACT

Escrow Officer:

Branch:

Sales Representative:

PROPERTY

Type:

ADDRESS

Address:

City:

Zip: State:

- OR - LEGAL

State:

Legal Description:

BUYER / BORROWER

	First	Middle	Last
1.
2.

Day Phone:			Cell Phone:
Evening Phone:			Pager:
Email:			Fax:

SELLER / OWNER

	First	Middle	Last
1.
2.

Day Phone:			Cell Phone:
Evening Phone:			Pager:
Email:			Fax:

ADDITIONAL INFORMATION

Requested Closing/Escrow Date:	Please Rush:
Preferred Closing/Escrow Officer:
Rate Lock Expiration Date:
Closing Document Expiration Date:

	Verify Homeowners Insurance
	Insurance Company Name:
	Phone:	Account Number:
	Verify Homeowners Association
	Association Name:
	Phone:	Account Number:
HAZARD INSURANCE INFORMATION
	Company Name:
	Agent Name:
	Agent Phone:	Account Number:

PAYOFF INFORMATION
	Order Payoffs/Demands
Enter lender information for payoff. At least one lender is required if payoffs exist.
(1)	Lender Name:	Loan Number: Loan Amount:
	Address:
	City:	State: Zip:
	Phone:	Fax:
	Email:

(2)	Lender Name:	Loan Number: Loan Amount:
	Address:
	City:	State: Zip:
	Phone:	Fax:
	Email:
	Instructions:

SEND A COPY

Send a Copy of the form to this Email:

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If you experience any difficulty with this online form, please contact your Fidelity representative for assistance. Thank you!

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.