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Serving the Greater Area of

Los Angeles, CA

Walnut Creek

Lender City National Bank 2001 N Main St, Suite 200 Walnut Creek, CA 94596

Additional Services
Customer/Employee Loan

Borrower Information (Name, address, phone)
2nd Borrower Information (Name, address, phone)

Social Security Number (Last 4 digits only)
Social Security Number - 2nd Borrower (Last 4 digits only)

Property Address (street, city, zip code)
Mailing Address of Borrower (if different from subject property)

Refinance Amount
New 1st Amount
A.P.N
New 2nd Amount
Lot & Tract
Estimated Closing Date

Please enter all of the information below so there will not be a delay in your order.

Loan Coordinator
E-mail
Loan Officer
Officer E-mail
Company phone (Please include extension)
Fax

*PAYOFF/SUBORDINATION INFORMATION: (FOR REQUESTING DEMANDS UNLESS OTHERWISE NOTED BELOW)

First Loan

Loan Number
Lender

Address (street, city, zip code)

Subordination
- Yes
- No
Payoff Amount

Second Loan

Loan number
Lender

Address (street, city, zip code)

Subordination
- Yes
- No
Payoff Amount

Additional loans/Charge accounts to pay at close of escrow
Notes Please open this order in SureClose.

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