Ernesto Martinez, Jr., P.A.

Ordered by:

Lender:

Mortgage Broker:

Telephone:

Fax:

Buyer/Borrower:

Telephone (Home):

Telephone: (Business):

Property Address:

County:

Legal Description:

Existing Mortgages (Lender):

Type of Loan:

Purchase*:

Refinance:

First Mortgage:

Second Mortgage:

Other:

* Please provide sales contract, any prior title information and Realtor name(s) and phone numbers(s).

Purchase Price:

Loan Amount:

Seller:

Telephone (Home):

Telephone (Business):

Services Requested

Title:		Inspections:
	Title Insurance Policy		Roof
	Title Insurance Policy w/Closing		Termite
	Update		Bacteriological Water Test
	Survey		Asbestos Report
	Mortgage Recording		Radon Test
	O & E Search		Plumbing Inspection
	O& E Search w/Closing		Electrical Inspection

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