Title Order Form

Requestor's Information

Name:

Phone: Email:

Property Information

Street:

City, State Zip:

Legal Description

Lot, Block and Subdivision OR

Section, Township and Range

Policy/Policies To Be Issued

Standard Owners Policy--Amount:

Extended Owners Policy--Amount:

Endorsements (check all that apply): 100 116 8.1

Proposed Insured (Buyer)

Name:

Street:

City, State Zip:

Phone: Fax:

Property Owner

Name:

Street:

City, State Zip:

Phone: Fax:

Closing Information

Closing Date:

Listing Agent/Agency:

Selling Agent/Agency:

Mortgage Company:

Loan Number:

Where would you like this information sent?

Name:

Street:

City, State Zip:

Phone: Fax:

Who will be billed?

Name:

Street:

City, State Zip:

Phone: Fax:

GuarantyTitleInc.