Order Title Insurance Ordered By (required) Attention Your Reference # Your Phone Your Fax Your Company Your Address Your Email (required) Would you like to use our escrow services: ---YesNo Please select your preferred escrow officer here: No PreferenceGail Van der HoeffJulie MooreCarol Spahr If you have a preference of underwriter, make your selection here: Old Republic National TitleFidelity National Title Type of Transaction: SaleLoanTSG/LitGuarOther If other, what type: For Owner's Policy, select the type and policy amount: StandardExtended Amount: For Loan Policy, select the type and policy amount: StandardALTAJunior Mortgage Amount: Property Information Seller's Name Phone Address Purchaser/Borrower Phone Address Lender's Name Phone Address Please check this box if there is a construction loan and the list the builder below. Builder Name Type of Property Single Family Res.Vacant LandCommercialDuplex3 or 4 PlexApartment Bldg. Is there a mobile home included in the sale? ---YesNo Property Address Legal Description (Please include information such as: Parcel Number, Lot, Block, Addition, etc.) Loan Officer Company Address Phone Fax Email Closing Officer Company Address Phone Fax Email Listing Realtor Company Address Phone Fax Email Selling Realtor Company Address Phone Fax Email Additional Information If you would like to print a copy of this order, please print from your browser window before clicking on the submit button. After you click "submit", confirmation will be displayed in the green box at the bottom of the screen. (You may have to scroll down to view this, depending on your browser.) Lewis County Title thanks your for your order!