NOTE: If you wish to use your own form, please feel free to fax it to us at 215-513-1780
or e-mail it to us at helen@evansabstract.com
  Order Information  
  Order Date:
  Your Name:
  Company:
  E-mail:
  Phone:
Fax:
  Anticipated Close Date:* 
(*NOTE: This date does not assume a locked-in settlement date. You need to call Evans Abstract to schedule date and time for settlement.)
  Transaction Type  
  Refinance Purchase
  Construction Loan Play Golf
  Sale / Appraised Value:  
  Mortgage Amount:  
  Refinance Amount:  
  Deposit Amount:  
  Evans Abstract to do Conveyancing: Yes  No
  MORTGAGE INFORMATION  
  Lender Name:  
  Payee Clause:  
  Contact Name:  
  Contact Phone Number:  
  Contact Fax Number:  
  Payoff Information (as applicable)  
  Name of Bank 1:  
  Account Number 1:  
  Contact Phone Number 1:  
     
  Name of Bank 2:  
  Account Number 2:  
  Contact Phone Number 2:  
     
  Name of Bank 3:  
  Account Number 3:  
  Contact Phone Number 3:  
     
  REALTOR INFORMATION  
  Buyer’s Agent:  
  Phone:  
  Fax:  
 
  Seller’s Agent:  
  Phone:  
  Broker Fax:  
  Commission (%):  
  Broker Service Fee:  
  Property to Be Insured  
  Street Address:
  Township/Borough:
  County:
  Tax ID:
  State:
  Borrower/Buyer Information  
  Name:
  SSN#:
  Spouse/Other:
  Spouse/Other SSN:
  Phone:
  Seller Information (Complete if applicable)
  Name:
  SSN#:
  Spouse/Other:
  Spouse/Other SSN:
  Phone:
  Special Instructions