Property Transfer Services, Inc - Order Title Insurance Form

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Request for Title Insurance Form

Please fill out the following to order any of our Title Insurance Services. Once your order is recieved, it will be given our immediate attention. You will recieve a Confirmation Email of your Title Insurance Order at the address you provide below.

PLEASE FILL OUT ALL APPLICABLE FIELDS.

Client Information
*Company/Lender Name :
*Contact Name:
*Address:
*City:		*State:	*Zip Code:
*Contact#:		Contact Fax:
*Contact Email:
*Transaction Type:	(Select a Transaction Type before continuing)
*Purchase/Sale Price:	(Enter Transaction amount. No Commas eg 120000.00)

Property Information
*Property Type:
*Street Address:
*City:	*State:	*Zip Code:
County:	Parcel ID#:

Loan Information
*Loan Amount:		New Loan #:
*Proposed Lender:
Clause(s):

Borrower Information

*Name of Borrower:

*SSN:

Co-Borrower:

SSN:

*Marital Status of Borrower:

*Mailing Address:

Click to Use Property Address

*City:

*State:

*Zip Code:

*Borrowers Phone#:

Work #

Cell Phone #:

Fax #:

Email Address:

Buyer Information

*Name of Buyer:

*SSN:

Co-Buyer:

SSN:

*Marital Status of Buyer:

*Mailing Address:

Click to Use Property Address

*City:

*State:

*Zip Code:

*Buyers Phone#:

Work #

Cell Phone #:

Fax #:

Email Address:

Real Estate Agent:

Contact#:

Seller Information

*Name of Seller:

*SSN:

Co-Seller:

SSN:

*Marital Status of Seller:

*Mailing Address:

Click to Use Property Address

*City:

*State:

*Zip Code:

*Sellers Phone#:

Work # :

Cell Phone #:

Fax #:

Email Address:

Selling Agent:

Contact#:

Existing Mortgages/ Equity Lines for Ordering Payoffs

Name of Bank for 1st Mortgage:					Account #
Name of Bank for 2nd Mortgage:					Account #
Name of Bank for 3rd Mortgage:					Account #

Home Owners Insurance Information

Name of Insurance Company:

Policy #:

Insurance Agent:

Contact #:

Insurance Types:

Hazard Insurance

Flood Insurance

Wind Insurance

Additional Information

Does a Boundary Survey Need to be requested for this property?

YES

Is this Property a Condo?

YES

*How Should We Send Confirmations, Correspondence & Documentation?

Comments or Special Requests

Please Add Any Additional Comments or Special Requests

Please only click the Submit button once. It may take several seconds for the submission to complete, clicking the Submit button more than once will result in multiple Orders.

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