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This form will also serve as your order for Title Insurance.
(* marks a required field)
*Customer Ordering:
E-mail:
Property Address:
City:
State:
Zip:


Sale Price:
Listing Agent:
Company:
Phone:

Selling Agent:
Company:
Phone:
Sale Price:

Commission:
Co-Broke Office:
Commission Split:
Closing Date:
Time:
Place:

If Seller has mortgage(s) against property -
PLEASE PROVIDE (from payment coupon):
Lender Name:
Lender Address:
City:
State:
Zip:
Loan Account Number:
Phone Number:

Lender Name:
Lender Address:
City:
State:
Zip:
Loan Account Number:
Phone Number:

Lender Name:
Lender Address:
City:
State:
Zip:
Loan Account Number:
Phone Number:

SELLERS:
Name:
S.S.#:
Address (if different from property being sold):
City:
State:
Zip:
Phone:
Attorney:

Name:
S.S.#:
Address (if different from property being sold):
City:
State:
Zip:
Phone:

BUYERS:
Name:
S.S.#:
Address:
City:
State:
Zip:
Phone:
Attorney:

Name:
S.S.#:
Address:
City:
State:
Zip:
Phone:
Attorney:

OFFER TO PURCHASE INFORMATION:

Please send copy of offer to purchase
and any addendums to Abstract & Title Co.

Earnest Money Amount:
Holder of Earnest Money:
Date Due:
Date Received:

ANY ADDITIONAL BILLS:
Name:
Address:
City:
State:
Zip:
Cost:
Paid?
Lien Waiver:
Name:
Address:
City:
State:
Zip:
Cost:
Paid?
Lien Waiver:
Name:
Address:
City:
State:
Zip:
Cost:
Paid?
Lien Waiver:
Name:
Address:
City:
State:
Zip:
Cost:
Paid?
Lien Waiver:

CLOSING INFORMATION:
Lender:
Address:
City:
State:
Zip:
Loan Officer:
Phone:
Fax:

Copies of title commitment should be sent to:
IF ORDER DEED/TRANSFER FORM/AFFIDAVIT
DOCUMENTS PLEASE COMPLETE THE FOLLOWING:
Does the seller have attorney representation?
If so, whom?
Is our office preparing and
conducting the closing documents?


Please provide the following information
for the documents to be drafted:
Documents needed by:


Address:
City:
State:
Zip:


Seller's NEW Address:
City:
State:
Zip:


Buyers wish to hold title as:




Is property seller's homestead?:


Is DLHR required?:


Is there any relationship
between seller and buyer?:
Type of Property:


Primary Use?:


Additional Comments:


Please provide our office with a copy of the Offer to Purchase.

   

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