Ordered By Loan # Estimated Closing Date     Buyers/Borrowers Home Phone     Buyer 1 Work Phone     Email Buyer 2 Work Phone     Email Sellers Property Address Brief Legal         Loan Type Conv Ins   Conv Unins   FHA   VA   Cash Sale   Purchase   Refinance   Home Equity Sale Price Loan Amount Mortgage Co Phone # Loan Officer Fax     Email Loan Processor Fax     Email Listing Agent Company Phone Email Selling Agent Company Phone Email         Survey -- Please Choose -- Yes No Title Exam -- Please Choose -- Yes No

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Home Services Title, LLC — 4060 Executive Drive, Dayton, OH 45430 — (937) 435-2580 — (937) 427-1216 - fax