MyREALTY.com Order Form – to place order from LLSS

Ordering Customer:

Ordered By Name:

Additional Notification:

Address:

City:

State:

Zip Code:

Phone:

Fax:

Email:

Proposed Insured:

Reference Number:

Order Date:

Due Date:

Estimated Closing Date:

Loan Type:

1st Mtg REFI
2nd Mtg REFI
HELOC
Purchase
Reverse Mortgage

1st Mortgage New Loan Amount:

2nd Mortgage New Loan Amount:

Services Being Ordered:

Title

Type: Please Select Refi-Short Form Property Report LCP Junior Loan Policy (2nd Mtg) Purchase Full Alta Refi Full Alta

Will our closing services be required on this order? Please Select Yes No

Appraisal

Please Select 2075 Drive By Automated Valuation Desktop Evaluation Duplex Field Review FNMA 1004 Single Family FNMA 1073 Condominium FNMA 2055 Exterior FNMA 2055 Interior FNMA 2065 Exterior Full Appraisal (2-4 Family) Partial Full Appraisal Quote Appraisal Re-Inspection OTHER

Flood Certificate

Property Information:

Property Type:

Please Select Primary Residence 2nd Home Investment Property

Property Address:

Property City:

Property State:

Please Select AL AK AZ AR CA CO CT DE DC FL GA HI IA ID IL IN KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VI VA WA WV WI WY

Property Zip Code:

Property County:

Borrower Information:

Borrower First Name:

Borrower Last Name:

Borrower SSN:

Co-Borrower First Name:

Co-Borrower Last Name:

Co-Borrower SSN:

Home Phone:

Work Phone:

Cell Phone:

Payoff Information:

Lender will order own payoffs

LLSS to order payoffs, but information not yet available

LLSS to order payoffs, and I have lender information now

PLEASE NOTE: If we are ordering payoffs for you, we will need a copy of the signed borrower's authorization.

Special Instructions: