Refinance

Open Escrow Request

Please complete the following information and fax or email this form to Southland Escrow, Inc.

New 1st Loan Amount:$

New 2ndLoan Amount:$

Borrower #1

First Name

Last Name

Borrower #2

First Name

Last Name

Borrowers Mailing Address

Property Address

Address1

Address 2

City

State

Zip

Country Code

Loan

Title Company

Title Rep to Credit

1st Lien Holder

Phone

Area Code

Phone First 3

Phone Last 4

2nd Lien Holder

Loan

Phone

Country Code

Area Code

Phone First 3

Phone Last 4

HOA Dues #1

HOA Dues #2

HOA & Management Name #1

HOA & Management Name #2

Broker Office Name

Loan Officer

Loan Officer Phone

Country Code

Area Code

Phone First 3

Phone Last 4

Loan Processor

Loan Processor Phone

Country Code

Area Code

Phone First 3

Phone Last 4

Special Instructions

Submit

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