Person Placing Order
Name
*
Need by
Company
*
FAX
Phone
*
E-Mail
Desired Service:
Title Insurance only
Title Insurance and Closing
Closing only
Search
Final Policy
*
Required Field
Property Information
Owner's Name
*
Key No.
Property Address
County
Address 2
Need deed
City, State, Zip
Need survey
Short Legal Description
*
Required Field
Buyer Information (If Sale)
Name
Sale Price
Loan Information
Loan Amount
Lender
Loan Officer
Phone
Closing Date
Fax
Conventional
Refinance
Construction
Special Instructions
ph: (765) 423-1642 • fax: (765) 742-2151
301 Columbia St., Lafayette, IN 47901
