Proceeds/funds Disbursement Form - First American Title

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First American Title
Phone 877-295-4328
To: First American Title
File No.:
Re: __________________________________________,
___________________________________ ("Property")
Proceeds/Funds Disbursement Instructions
Proceeds: The undersigned directs that the proceeds/funds due will be disbursed in the following manner:
[ ] Mailed to the address below
[ ] Sent via overnight delivery
[ ] Sent via wire transfer **
[ ] Other:________________________________________
** If checked, attach wiring instructions of receiving bank or fill in below.
With cyber fraud on the
increase, we suggest you mail, use an overnight service or hand-deliver any items
containing banking or other private information and not send via email.)
Bank Name:
Name on the Acct: ___________________________________________________
Account No.:
Routing No.:
_____ ____________________ __________________________
Phone No.:
Type of Account:
Any further instructions: ________________________________________________________________
Please Note:
Modified or amended disbursement instructions must be signed by the parties at a First
American office. Proof of identity will be required.
Funds disbursed to other than record owner must be in writing with authorized approval by First American
Title Company and possibly buyer/borrower’s lender on a TILA-RESPA Integrated Disclosure (TRID) regulated
Receiving Banks may impose a charge for the receipt of any wire transfers.
Escrow Holder is not responsible for delays in wiring caused by time restrictions of the Federal Reserve
Board or late confirmation of recording.
When funds are sent to a bank outside the United States, Escrow Holder shall not be responsible or liable
for any loss or expense incurred as a result of currency exchange rates, delays in availability of funds, or delays
due to the U.S. bank or foreign bank requiring additional information. Escrow Holder shall have no liability or
responsibility after properly initiating the outgoing wire transfer.
The undersigned acknowledge that the Proceeds/Funds Disbursement Instructions are
complete and accurate.
Print Name(s): _________________________________________________
Home Phone:
Cell Phone:
Business Phone:


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