Your Name (Required):

Your Email Address (Required):

SELLER(S):
Last Name:	First Name(s):
Address:
City, State, Zipcode:
Phone:	Fax:
Email:

PURCHASER(S) / BORROWER(S)
Last Name:	First Name(s):
Address:
City, State, Zipcode:
Phone:	Fax:
Email:

LENDER(S):
Name:
Address:
City, State, Zipcode:
Phone:	Fax:
Contact Person:
Email:

PROPERTY:

Tax ID Number:

County: City/Township:

Lot/Block #: Subdivision:

Legal Description:

Unit #: Condominium:

Section/Town/Range #: Part of Quarter:

POLICY:

Owner's Policy Amount:

Mortgage Policy Amount: with exceptions without exceptions construction

Please select one: Preliminary title commitment only 40 year title search / title search to last deed of record Other - Please specify:

ADDITIONAL INSTRUCTIONS:
Send to: Seller Purchaser Lender Other (See Below)
Name:
Address:
City, State, Zipcode:
Phone:	Fax:
Email:

To the attention of: Anyone in the Office Paula Barron John Taylor Jody Amick Peggy Chaika Kim Engstrom Lisa Ernst Peggy Evans Sue Haviland Jessica Lockman Karla Lockman Krista Meggison Melissa Raquepaw Sharon Russell Paula Selonke Susan Shepperly Julie Supernaw Lynn Sutton Debra VanLoo Lynette Webb

Please fax us any previous title work when submitting the order to receive re-issue credit on the invoice. When doing so, please reference your email order - our fax number is 231-547-7040. Will we be conducting your closing? If so, we will need a copy of the purchase agreement as submitted as well.

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