Quality Title - Owner order

Owner's Policy Order Form

To place a title insurance order, please enter the following information:

	Order Purchase Transaction
	Order Preliminary Report/Search & Hold (complete * items only)

Ordered by:
*First name:
*Last name:
*Company name:
*Address:
*City:			*State:		*Zip:
*Phone number:			*Fax number:
*Email address:

Sales price:
*Property address:
*Tax Parcel #:
Anticipated closing date:

Listing broker:			Selling broker:

*Sellers name(s):
Sellers forwarding address:
City:			State:		Zip:
Phone number:			Email address:

Sellers Attorney:
Phone number:			Fax number:
Email address:

Buyers name(s):
Buyers address:
City:			State:		Zip:
Phone::			Fax number:
Email address:

Buyers Attorney:
Phone number:			Fax number:
Email address:

Buyers Lender:
Loan Officer:
Phone number:			Fax number:
Email address:

Do you have the following:
Prior title:		Yes	Abstract:			Yes
		No				No

Other:
Date needed:

Closing Statement Preparation:
Prepare closing statements:				Yes
				No
Commission amount or percent:
Homeowners warranty:				Yes*
				No
* if yes, amount and company name:			Amount:
			Company name:

Any additional invoices:

Deed Preparation Information:
Buyers to take title as:
	Husband and wife, survivorship marital property
	Single
	As tenants in common

Buyers moving to property?				Yes
				No

Homestead of seller?				Yes
				No

Is Seller related to Buyer?				Yes*
				No
* if yes, what is relationship:
Primary use of property:
	Residential
	Commercial
	Agricultural
Type of transfer:
	Sale
	Gift
	Exchange
	Other:
Lot size or acreage:

Additional comments:

WE APPRECIATE YOUR BUSINESS!

Quality Title, Inc.

102 S Court Street Merrill, WI 54452
Phone: (715) 539-2822 Fax: (715) 536-7123