Please enter the following information to order Title Insurance Services.
* = 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 provide us with the details of this transaction in the "comments" section at the end of this form.
TOTAL SALES PRICE (ALL SITES):
TOTAL LOAN AMOUNT (ALL SITES):
PROPERTY INFORMATION
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
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 names in the "comments" box at the bottom of this form.
PHONE NUMBER:
FAX NUMBER:
E-MAIL ADDRESS:
PRIMARY BUYER / BORROWER.
 
TYPE OF ENTITY:

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

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

Other:
DELIVER TO:

Other:
"Please provide the names and address of all parties you selected to receive deliveries in the "comments" box at the bottom of this form unless this information appears was provided above.
PROJECTED SETTLEMENT DATE:
 month: day: year:
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.

The Contact Party acknowledges that submitting this Web Title Order Form by clicking the SUBMIT box below represents an intention to order title work, products and/or services from Commercial Title Group, Inc. ("CTG") and an agreement to pay the normal and customary charges of CTG for the services requested. No order will be processed until a company representative verifies your request at the email address or phone number shown on "Your Contact Information" above.