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Web Order Entry

In addition to ordering title and closing services by telephone, e-mail and fax,
you may order and initiate title and closing services via RandallSegrest.com

To initiate an order, please fill out the form below.  For best results, enter as much
information as is available and use ALL CAPS and no unnecessary punctuation.

Processing will begin promptly. Thank you.

Transaction Type:	Purchase Refinance Equity
Buyer/Borrower(s):		Example: JOHN Q. SMITH
		Example: SALLY R. SMITH
Seller(s):		Example: CHRISTOPHER K. PUBLIC
		Example: JENNIFER PUBLIC
Contract Sales Price:		Example: 195000.00
Earnest Money:		Example: 5000.00
Held/Received By:	Incoming Fund Seller Settlement Agent Listing Agent (701) Selling Agent (702)
Property Address:		Example: 1024 ELM STREET
City:		Example: RALEIGH
State:		Example: NC
Zip:		Example: 27606
County:		Example: WAKE
Listing Agent Company Name:		Example: REMAX
Phone:	(###)###-####	Example: (919)555-1234
Total Commission Rate %:		Example: 6
Selling Agent Company Name:		Example: UNITED REALTY
Phone:	(###)###-####	Example: (919)555-4321
Lender Name(s):		Example: BANK OF USA
Street Address:		Example: 123 MAIN STREET
City, State, Zip		Example: RALEIGH, NC 27609
Settlement Date:	MM/DD/YYYY	Example: 10/03/2004
Time:	hh:mm	Example: 09:27
Settlement Status:	Firm Pending Tentative Completed Canceled Hold Set Closed Shipped Follow-Up
Status Comment:
Electronic Attachment 1:		Optional: Relevant Files
Electronic Attachment 2:
Electronic Attachment 3:
Electronic Attachment 4:
Order Notes:
Please include your email address below. You should receive a confirmation email shortly after you submit this form.
Your Email Address: