Please provide proper spelling and wording of your name, as you would like to show on title. Please notify us immediately if, a Power of Attorney will be needed. We shall be pleased to accommodate this request on your behalf.

Closing Location:  
Re: (Property Address)  
Our Case #:
PURCHASER # 1
Name:   Address:
Phone:   City:
Cell: State:   Zip:
Fax:    
Email:   *SSN:
PURCHASER # 2   
Name: Address:
Phone: City:
Cell: State:   Zip:
Fax:    
Email: *SSN:
* SSN - If you are not in secure location with secure internet access, please call our office with this information. 
TENANCY SELECTION (PLEASE CHECK CHOICE):
TITLE INSURANCE:
Title insurance is a protection, available to purchasers and lenders of real estate, which places the title insurance company in the position of defending, at its costs and its risk, up to the policy amount, any special claims against the property not excepted by the policy. The title insurance policy protects the insured against loss should the condition of title to the land be other than as insured.
Select Title Insurance:
SURVEY:
A House Survey insures that the house is fully within the lot lines and the property being conveyed is accurately identified in the contract. The cost is typically $250.00-300.00.
WOULD YOU LIKE US TO ORDER A SURVEY?
LENDER INFORMATION:
Lender:  
Lender’s Name:
Loan Officer:
Loan Processor:
Address:
City:
State: Zip:
Telephone Number:
Fax Number:
SELLING AGENT INFORMATION:
Agent:  
Agent Name:
Agent’s Affiliated Company:
Address:
City:
State: Zip:
Email:
Telephone Number:
Fax Number:
   
Please review your submission. If all the information is correct, press the "Complete Submission" button.