BRIGHTMAN AGENCY, INC.

A FULL SERVICE TITLE AGENCY
Serving New Jersey & Pennsylvania

Member — NJLTA
Member — Chamber of Commerce

Services

Refinance, Purchase and Foreclosure Transactions
Residential Title Insurance
Commercial Title Insurance
Property, Lien & Judgment Searches
Closing/Settlement Services
Signing Services
Notary Services
Title Examinations
Title Reports
Other Title and Escrow Related Services Upon Request

Real Estate Professionals:
Click here for a complete Title Order Form.

Financial/Lending Professionals:
Click here for a complete Title Order Form.

Non-Professionals:
Click here for an abbreviated Title Order Form.

TITLE ORDER FORM
Refinance Transaction

(*required field )

ORDER INFORMATION

*ORDER DATE:

*Company Requesting Services:

*Person Placing Order:

Loan Officer:

Loan Processor:

*Contact Phone Number:

*Email:

SERVICES REQUESTED

*Title Commitment Package

Yes No

*Mortgage/ Creditor Payoff(s) Needed?

Yes No

*New Deed Required?

Yes No

METHOD OF DELIVERY FOR COMPLETED TITLE SEARCH/COMMITMENT

*Select delivery method for completed title search/commitment.

Faxed E-mailed Pick Up

*E-mail of Person Ordering the Title Work:

*Fax of Person Ordering the Title Work:

BORROWER(S) INFORMATION

*Primary Address:

*City:

*County:

*State:

*Zip Code:

*How long has borrower resided at this address?

years
months

*Borrower

Female Male

*Legal Name:

*Home Phone:

*Work phone:

*Cell phone:

Social Security Number:

Date of Birth:

DL#:

*Marital Status:

married separated divorced single

If you are married you must provide spouse's information

Co-Borrower/Spouse:

Female Male

Legal Name:

Home Phone:

Work phone:

Cell phone:

Social Security Number:

Date of Birth:

DL#:

Marital Status:

married separated divorced single

On Title Only (Not on Loan)

PROPERTY INFORMATION

*Refinance is on a

Primary Residence Second Home Investment Property

Address of Refinance (if different from above):
Address:

City:

State:

Zip Code:

*Is Property A Condominium?

Yes No

*Is There An Association?

Yes No

*Association Name

*Association Phone Number

*How Long Have You Owned This Property?

years
months

Existing Mortgage(s) Information

Mortgage Company(s):

Telephone Number(s):

Loan Number(s):

Amount of New Loan:

Name of New Lender/Investor:

Mortgage Clause:

Name:

Address:

City:

State:

Zip:

Additional Comments/Notes: