Please enter the following information to request a quote.
* = Required

YOUR CONTACT INFORMATION
FIRST NAME:
 *


LAST NAME:

*
STREET ADDRESS:
CITY:
 *
STATE:
*
ZIP CODE:
 *
PHONE NUMBER:
 *
FAX NUMBER:
E-MAIL ADDRESS:
 *

CONTACT PARTY IS:
Please check all that apply.
Counsel for Purchaser/Borrower Purchaser/Borrower
Counsel for Seller Seller
Counsel for Lender Lender
Realtor representing Seller Realtor representing Purchaser
Loan Broker Other:

GENERAL INFORMATION
TRANSACTION INVOLVES:
SERVICES REQUESTED:


If you selected "other", please provide us with the details of this requested service in the "comments" section at the end of this form.

TRANSACTION TYPE:

*
If you selected "other", please complete the field below.
OTHER:
TOTAL SALES PRICE:
(ALL SITES)


If more than one property, please show total sales price.
TOTAL LOAN AMOUNT:
(ALL SITES)


If more than one property, please show total loan amount.
PROPERTY INFORMATION
You must complete the required field(s) marked with a * - the remaining fields are not required until an order is placed.
TOTAL NUMBER OF SITES IN THIS TRANSACTION:

ADDRESS:

Please complete and submit the following information for each site.
I prefer to fax this information.
If box this box is selected, please fax property information for each site to (703) 506-9615 Attn: Title Order Department, and proceed to party information.
CITY:
STATE:
*
CITY/COUNTY:
TAX MAP/I.D. NUMBER:
LEGAL DESCRIPTION:
PARTY INFORMATION
This information is optional - most items will be required when an order is placed.
PRIMARY SELLER.
 
TYPE OF ENTITY:

Other:
RECORD OWNER NAME:
CONTACT PERSON:
MAILING ADDRESS:
CITY:
STATE:
ZIP:

ADDITIONAL SELLERS:


Please check this box if there are additional sellers and include the additional seller name in the "comments" box at the bottom of this form.
PHONE NUMBER:
FAX NUMBER:
E-MAIL ADDRESS:
PRIMARY BUYER / BORROWER.
 
TYPE OF ENITITY:

Other:
COMPANY NAME:
CONTACT PERSON:
MAILING ADDRESS:
CITY:
STATE:
ZIP:
ADDITIONAL BUYERS / BORROWERS:

Please check this box if there are additional buyers and include the additional buyer names in the "comments" box at the bottom of this form.
PHONE NUMBER:
FAX NUMBER:
E-MAIL ADDRESS:
ADDITIONAL INFORMATION
PROPOSED SETTLEMENT DATE:
 month: day: year:

DATE SERVICES NEEDED:
month: day: year:
DELIVER BY:

Other:
COMMENTS:
Contact me for additional information

EXISTING TITLE POLICY:

If you selected "yes", please fax your Existing Title Policy to (703) 506-9615 Attn: Title Order Department. Please reference "Web Title Order" on your fax.