Premier Leads Form
To place An Order Or For More Information On A Fidelity Partnership, Click Here.

Fidelity National Title Agency

Broadway Office:
520-290-6227

Oracle Office:
520-529-9022

Joesler Office:
520-837-0180

Kolb Office:
520-837-0187

Premier Leads Form

YOUR INFORMATION

First Name: *
Last Name: *
Email Address: *
Ordering Party:
Company Name: *
Address:
City:
Phone #:
Fax #:
Cell:

PLEASE IDENTIFY YOUR FIDELITY CONTACT

Escrow Officer:
Branch:
Sales Executives     *

LEAD INFORMATION

GEOGRAPHIC AREA
1st MORTGAGE INFORMATION



Loan Type:
Fha
VA
Conventional
All

Interest Rate Type:
Variable
Fixed




Include In Report:
Owner Occupied
Absentee Owner
No Preference
Only Records W/ Phones
2nd MORTGAGE INFORMATION


SERVICES REQUESTED

  

If yes, check appropriate box for label format:

Label Format:
 Site Address
Mail Address



Delivery Method: Choose At Least One



Include:
Owner Name
Owner Name + or Current Resident

Format:
Excel
CSV
ASCII (Comma Delimited)
PDF
Hard Copy

SPECIAL INSTRUCTIONS

Any additional information or instructions:

SEND A COPY

Send a Copy of the form to my Email:

Please press Submit button one time only. If you experience any difficulty with this online form, please contact your Fidelity representative for assistance. Thank you!

Fidelity National Title Agency

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