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 Title Fidelity National Title

Type of Transaction:
 Sale Loan TSG/LitGuar Other

If other, what type:

For Owner's Policy, select the type and policy amount:
 Standard Extended
Amount:

For Loan Policy, select the type and policy amount:
 Standard ALTA Junior 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 Land Commercial Duplex 3 or 4 Plex Apartment 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!