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TITLE ORDER REQUEST FORM

TITLE ORDER REQUEST FORM

PHONE: 1-859-721-2124 / EMAIL: [email protected]

BUYER / OWNER

BUYER

OWNER

Full Name

PROPERTY ADDRESS:

COUNTY:

LOT NUMBER(S):

SUBDIVISION NAME:

DEED BK/PG:

ATTACH COPIES OF ALL DEEDS

IF NEW PURCHASE, PURCHASE PRICE:

Will This Be: *

LENDER’S POLICY

PURCHASE

FIRST MORTGAGE

OWNER’S POLICY

REFINANCE FIRST MORTGAGE

SECOND MORTGAGE

OPINION ONLY

NEW TITLE

TRIFECTA TITLE TO ORDER:

DEED

Yes

No

PROTATE TAXES?

Yes

No

POSS WITH DEED?

Yes

No

MORTGAGE

Yes

No

LENDER:

MTG AMT:

TYPE OF MTG:

MTG FORM TO USE:

REQUIRE A SURVEY

Yes

No

REQUIRE A MORTGAGE INSPECTION

Yes

No

REQUIRE A UCC SEARCH

Yes

No

BUYER INFORMATION:

FULL NAME OF BUYER:

MARITAL STATUS:

Single
Married
Divorced
Separated
Widowed
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FULL NAME OF SPOUSE (IF ANY):

CURRENT MAILING ADDRESS:

DEED/TAX BILL MAILING ADDRESS:

HOW IS PROPERTY TO BE TITLED (JTROS, BUYER ONLY, ETC):

IF MORE THAN ONE BUYER, PLEASE LIST ADDITIONAL BUYER INFORMATION AND EMAIL TO [email protected]

SELLER INFORMATION:

FULL NAME OF SELLER:

FULL NAME OF SPOUSE (IF ANY):

CURRENT ADDRESS:

FORWARDING ADDRESS:

IF THE PRESENT OWNER IS NOT THE PARTY LISTED ON THE SOURCE DEED (DIVORCE, DEATH, ETC), PLEASE EXPLAIN:

IF MORE THAN ONE SELLER, PLEASE LIST ADDITIONAL BUYER INFORMATION AND EMAIL TO [email protected]

TITLE SEARCH REQUESTED BY:

REQUESTER’S EMAIL:

PLEASE RETURN TO:

PHONE NUMBER:

PLEASE ALLOW 4-5 WORKING DAYS

A FULLY EXECUTED COPY OF THE AFFILIATED BUSINESS ARRANGEMENT DISCLOSURE MUST ACCOMPANY ALL ORDERS

Affiliated Business Arrangement Disclosure *

Copy of The Source Deed:

Copy of Purchase Contract:

Each office is independently owned and operated.