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Lender

Please complete and submit the online application for title and closing services. If this is a purchase transaction, please upload an excuted contract with your order. All forms are secure for submitting information.

Order Placed By:

First Name

Last Name

Company Name

E-mail

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Phone Number

Fax Number

Purchaser(s)/Borrower(s):

Name

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Lender loan amount

Property Information:

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Phone Number

Selling Agent

Purchase Price

Lender

Loan Amount

Type of Transaction

If title insurance is required, please check additional endorsements required:

EPL (ALTA 8.1) Survey Coverage (Remove Exceptions) Condominium (ALTA 4) Planned Unit Development (ALTA 5) Variable Rate (ALTA 6) Comprehensive (ALTA 9) Location (ALTA 22)

Additional Comments:

Documents To be:

E-mailed Uploaded Mailed Faxed Dropped off (Delivery Fee Additional)

Upload Documents

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975 Swinnea Ridge, Suite 2, Southaven, MS 38671, USA
662-400-6297
neworder@legacytitleandescrow.com
admin@legacytitleandescrow.com
(Fax) 833-689-1201