Title Order Management

Abstractor Registration

Company Name:^*

(Same as it reflects on your W-9)

Do you have Form W-9?^*

Yes No

*If yes, please attach a copy of your current Form W-9.

How many years of experience do you have performing abstracts for the purpose of real estate transfer, or conveyance of title, for attorneys, abstract companies and/or title insurance companies?^*

Primary Contact:^*

Additional Contact:

Street Address:^*

Mailing address same as street address

Mailing Address:

Office Phone:^*

Mobile Phone:

Email:^*

Fax:

Website:

Can you be reached at all times during the work day?^*

Yes No

If not, at what times may we contact you?

Do you have computer access to county records, in office?^*

Yes No

What is your source of title information?

Plant Court/Recorder's office

If you use a plant

Plant Name:

Plant Owner:

Type of Plant:

How current is plant?

Does plant have E&O coverage?

Yes No

Questionnaire

Do you have E&O insurance?^*

*If yes, please attach a copy of your current E&O insurance certificate.

Yes No

Are you or the company licensed?^*

*If yes, please attach a copy of current license.

Yes No

Are you an agent for any title insurance underwriters?^*

If so, for whom?

Yes No

Do you have any claims/judgements pending or have you had any filed against you in the past related to any real estate transaction(s)?^*

Yes No

Have you been arrested for a felony in the past?^*

Yes No

Is the Company/Agency Minority Owned?

Yes No

How many orders can you, and/or your staff, handle per day?

Please upload coverage document as per the template^*

Coverage document template.xlsx

Please provide a list of your abstractors that will provide service for Orchestrate Mortgage & Title Solutions, LLC

Abstractors Name

Years of Experience

Do you have a qualification process in place for your network of abstractors?^*

Yes No

Abstractors Account Details - ACH/Direct Deposit Payment Authorization

Mode of Payment:

Name and Contact Details:

Name(As it Appears in Bank Account):

Bank

Routing No.

Account No.

Comments/Remarks