Today's Date
 
Need By Date
 
Estimated Closing Date

  Contact Information
 
Name
 
Company
 
Address
 
City
 
State
 
Zip Code
 
Phone Number
 
Fax
 
Email

  Buyer / Borrower Information (if additional space is needed please list in Additional Comments)
 
Name
 
 
 
Name
 
 
 
Address
 
City
 
State
 
Zip Code
 
Phone Number
 (Work)
    (Home)
 
Email

  Seller Information (if additional space is needed please list in Additional Comments)
 
Name
 
 
 
Name
 
 
 
Address
 
City
 
State
 
Zip Code
 
Phone Number
 (Work)
    (Home)

  Property Information
  County
  Other
  Address
  City
  State
  Short Legal Description
  Is there a prior title policy available Yes No
    If yes, please fax to us at (812) 346-6056

  Lender Information (If same as Contact Information - leave blank.)
 
Name
 
Company
 
Address
 
City
 
State
 
Zip Code
 
Phone Number
 
Fax
 
Email

  Transaction Information
 
Sales Price
 
Loan Amount
 
Type of Loan
 FHA
VA
Conventional
Cash
Contract

  Services Ordered
  Title Search One Owner
  Title Search 20 Year
  Title Search Year
  Title Insurance Loan Owner
  Do you need a deed ordered? Yes No
  Preference of Attorney
  Attorney Phone Number
  Title to be held
  Do you need us to order a Surveyor Location Report? Yes No
  Preference of Surveyor
  Surveyor Phone Number
  Other

  Payoffs to be Ordered
 
Lender
 
Phone Number
 
Account Number
 
 
 
Lender
 
Phone Number
 
Account Number
 
 
 
Lender
 
Phone Number
 
Account Number
 
 
 
Lender
 
Phone Number
 
Account Number
 
 
 
Lender
 
Phone Number
 
Account Number
 
 

  Additional Comments

 
   

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