Title Insurance/Property Report Order Form Today's date: Nov 20, 2008 6:39 pm US/Eastern (Note: Orders received after 3pm E.S.T. (15:00:00) are considered next business day) This Request is from: Company Name: Requester's Name: Address: City: State: Zip Code: Phone: Fax: E-Mail: Charge To (if different from above): Loan Information Type of loan (please check one): Refinance Home Equity 2nd Mortgage Other type of loan Curative Service(please select one) Yes No PAC Settlement Services(please select one) Yes No Request for Last Owner Property Report Only (No Title Insurance Required) Request for Title Insurance Property Information Property Location: City/Town/Village: County: SBL#: Deed Information: Liber Page(s) Recorded Borrower Name Daytime Phone If deed available please e-mail or fax (585.423.8273) Mortgage Amount Mortgage Type (check one): Fixed Adjustable Lender Information Lender's Name Lender's Attorney Name Lender's Attorney Address: Lender's Attorney City Lender's Attorney State Lender's Attorney Zip Code Lender's Attorney Phone Comments