TITLE SERVICES REQUEST FORM FOR LENDERS

Date:

Your Email Address:

From: Phone: Fax:

Contact Person:

Property Address:

Borrower(s) Name:

Borrowers Address (if different than above):

Marital Status

Borrower(s) Phone:

Borrower(s) SS#

Spouse's SS#

Sale Involved: Sellers Name:

Sellers Phone:

Seller's Address:

City: State: Zip:

County:

Legal Attached:

Proposed Closing Date

Borrower(s) Insurance Company

Proposed Insured/Lender

Mortgage Amount

Survey Required

Borrower Looking to:

Payoffs to:
(1st) Account #
Phone:

Payoffs to:
(2nd) Account #
Phone:

Special Instructions:

Feel free to email us if you have any questions or comments at info@acsknoxtitle.com
ACS Title and Closing, 109 East High Street, Mount Vernon, Ohio 43050
(740) 393-7777 Toll Free: 1-866-393-7773	Facsimile: (740) 392-2365