Pacific Coast Escrow Corporation Escrow Refi Request This form will help you open your Escrow. ALL FIELDS ARE REQUIRED. If all the fields are not complete you will be unable to submit your Escrow Request.

PROPERTY ADDRESS: Borrowers Name: Mailing Address: Borrowers Home Phone: Borrowers Work Phone: Borrowers Cell Phone: Borrowers Fax:     HIS Social Security: HER Social Security:     Borrowers Vesting: Single Man (Never Married) Single Woman (Never Married) Widow Widower Married Man as His Sole & Separate Property Married Woman as Her Sole & Separate Property Unmarried Man (Divorced) Unmarried Woman (Divorced) HusbandWife, as Joint Tenants Husband & Wife, as Community Property Husband & Wife, as Community Property wRight to Survivorship Husband & Wife, as Tenants in Common New Loan Amount: Type of Loan: Conventional FHA VA Termite Report if FHA or VA: Yes No Does Borrower Occupy Property: Yes No     Special Instructions: Lender Company: LOAN OFFICER: Lender Address: Lender PHONE: Lender FAX:     Title Company: Title Co Sales Rep:     First Payoff Lender: FIRST LOAN NO: 1st Lender Address or Phone: Second Payoff Lender: SECOND LOAN NO: 2nd Lender Address or Phone: