NATIONAL EXCELSIOR COMPANY
18500 NORTH CREEK DRIVE
TINLEY PARK, IL 60477
REQUEST FOR ESCROW JOB APPROVAL
DATE: _______________________ ORDER AMOUNT $________________
APPLICANT: COMPANY NAME ______________________________________
SELECT ONE: SOLE PROPRIETOR
PARTNERSHIP
CORPORATION LLC YES/NO
ADDRESS: ______________________________________________
CITY,STATE, ZIP _________________________________________
PHONE ( )__________________ FAX ( )__________________
PROJECT CONTACT ______________________________________
CONTACT E-MAIL ________________________________________
PROJECT: JOB NAME ________________________________________________
JOB ADDRESS _____________________________________________
CITY, STATE, ZIP __________________________________________
FUNDING BANK ___________________________________________
BANK ADDRESS ___________________________________________
CITY, STATE, ZIP ___________________________________________
ESCROW AGENCY: AGENCY NAME ______________________________________
ADDRESS ___________________________________________
CITY, STATE, ZIP _____________________________________
ESCROW CONTACT __________________________________
PHONE ( ) __________________ FAX ( ) _______________
ESCROW # _______________________________
Applicant agrees to National Excelsior Company standard terms and conditions of sale (copy attached); and further authorizes lending or escrow agency to release verification to National Excelsior Company for the purpose of extending credit terms for the aforementioned project.
Signature _________________________ Print Name ________________________
Form: Escrow 05/10 EAP