Vintage Title Order Form

Type of Order   Title Insurance Limited Title Search Closing Title & Closing
Ordered By
First Name:
Last Name:
Company Name:
Phone:	(###)-###-####	Example: (308)-123-1234
Address:		Example: 1234 Vine Street
City:		Example: Kearney
State:		Example: NE
Zip:		Example: 68505
E-mail:		Example: myname@domain.com
Fax:
Property Address
Property Address:
City:
State:
Zip:
County:
Tax ID Number:
Property Legal Description:
Sellers
Seller(1) Name:
Current Address:		Example: 1234 Vine Street
City, State, Zip:		Example: Kearney, NE 68505
Seller(2) Name:
Phone (work):	(###)-###-####
Phone (home):	(###)-###-####
Address after sale (if different):
City:
State:
Zip:
Buyers or Owners (if a refinance)
Buyer(1) Name:
Current Address:
City, State, Zip:
Buyer(2) Name:
Phone (work):	(###)-###-####
Phone (home):	(###)-###-####
Type of Transaction
Purchase Refinance Equity
Type of Policy
Lender's Owner's Both
Type of Mortgage
Mortgage:   First Mortgage 2nd Mortgage Construction
Financing:   Conventional Conventional PMI FHA VA Seller
Cash  Other
Lender to be Insured:
Loan Officer:
Mortgage Amount:		Example: 195000.00
Sale Price:		Example: 200000.00
Closing Date:	MM/DD/YYYY	Example: 10/15/2005
Date Commitment Needed:	MM/DD/YYYY	Example: 10/15/2005
Lender Address:
City, State, Zip:
Phone:
Fax:
Additional Requirements: (endorsements needed, specific cert needed, etc.)
Listing Agent
Agent's Name:
Phone:	(###)-###-####
Agent Address:
City, State, Zip:
Company:
Selling Agent
Agent's Name:
Phone:	(###)-###-####
Agent Address:
City, State, Zip:
Company:
Send copies of the commitment to the following:
Listing Agent Selling Agent Lender
Additional copies to: (Please include address)
Additional Information: