HomeTown USA Title Agency - Title Order Form

To order your title please fill out the following form. Fields in RED are required.
PERSONAL INFORMATION	Your Full Name
	Your Phone Number
	Your e-mail Address

PROPERTY INFORMATION	Address
	City
	State			Zip Code
	Parcel Number
	Termite Inspection
	Sale Price
	Well					Septic
	Back Title		You need us to pick it up
			You will fax it to us
			You need us to call the seller
	Contact		It's not available
			You need us to pick it up
			You will fax it to us

AGENCY INFORMATION	Listing Broker
	Listing Agent
	Phone Number
	Fax Number
	Commission		%
	Selling Broker
	Selling Agent
	Phone Number
	Fax Number
	Commission		%

SELLER'S INFORMATION	Seller's Full Name
	Seller's Work Phone Number
	Seller's Home Phone Number
	Seller's Fax Number
	Marital Status		Married
			Single
			Divorced and not Remarried
			Widowed and not Remarried
	Spouse's Full Name
	Spouse's Work Phone Number
	Spouse's Fax Number
	Mortgage Company
	Account Number

BUYER'S INFORMATION		Buyer's Full Name
		Buyer's Home Phone Number
		Buyer's Work Phone Number
		Buyer's Fax Number
		Marital Status	Married
			Single
			Divorced and Not Remarried
			Widowed and Not Remarried
		Spouse's Name
		Spouse's Work Phone Number
		Spouse's Fax Number

BUYER'S LENDER INFORMATION		Lender Name
		Contact
		Address
		City
		State			Zip Code
		Phone Number
		Fax Number
		Amount
		Loan Type	Conventional
			FHA
			VA
		Other

CLOSING INFORMATION		Location
		Date	/ /
		Time					a.m p.m
		Draw Deed	yes no
		Deed Type	Survivorship
			Warranty