Title Services Order Form

Fields marked with an asterisk (*) are required.

Ordered By *

With

Phone Number * Please include area code

E-mail Address *

Date Ordered

Need By Date

Estimated Closing Date (if applicable)

Title Insurance Yes No

Letter Report Yes No

JLP Yes No

Deed & Transfer Return Yes No

Other (Please Describe Below) Yes No

Other Description

Property Address*

Property City*

Property State* — Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Property Zip Code*

Parcel No.

Seller/Owner Name

Buyer Name

Lender

Listing Realtor

Listing Realtor Commission %

Or Listing Realtor Commission $

Selling Realtor

Selling Realtor Commission %

Or Selling Realtor Commission $

Legal Description

If Ordering Title Insurance...

Purchase Price

Loan Amount

Construction?

Second Mortgage?

Endorsements

Comp. Yes No

Location Yes No

Environmental Yes No

ARM Yes No