Davies & Grist, LLP 14045 Ballantyne Corporate Place
Suite 140
Charlotte, NC 28277
Phone: 704.731.0600
Fax: 704.731.0606
Title Search Request Form
From:
Mortgage Broker:________________________________________________________
Phone: ______________________ Fax: ________________________
Loan Processor:____________________
Purchase:________ Refinance: ______ Lease Option: ______ Non-Owner: ______
(provide sales contract)
Manufactured Home: YES/ NO
Projected Closing Date: ________________________
Borrower’s FULL Name: ________________________________________________________
Marital Status: _________________
Spouse’s Full Name:_______________________________________
S. S. #: ________________________________________________________
Seller’s name:_________________________________________________________
Spouse’s Full Name:______________________________________________________
Marital Status:_________________________________________________________
S. S. #:_________________________________________________________
Property address: _________________________________________________________
Street address
_________________________________________________________
City State Zip Code
Loan Amount: $______________________
Mortgagee Clause: _____________________________________________________
