Welcome to Community Title Company

SERVICE REQUEST FORM

Please complete the order form below as much as possible so that we may expedite your request.
items marked with an * indicates a required field

Full Search		Witness Closing Only
One Owner Search		1031 Exchange
Title Opinion Letter		Survey
Owners Title Policy		Appraisal
Mortgage Title Policy		Flood Certification
Closing/Document Prep
Other Service	(Describe)

REQUESTOR INFORMATION

Company:

Name:

Phone:

Fax:

E-Mail:

BUYER/BORROWER INFORMATION

Name:

Spouse:

Home Phone:

Work Phone:

E-Mail:

SELLER INFORMATION

Name:

SS#

Spouse:

Home Phone:

Work Phone:

E-Mail:

PROPERTY INFORMATION

Address:

City, State Zip:

County:

Legal Description:

Sales Price:

EXISTING MORTGAGE INFORMATION

1st Mortgage

Account No.:

2nd Mortgage

Account No.:

LOAN INFORMATION

Loan Amount:

Lender:

Contact:

Phone:

E-mail

LISTING AGENT INFORMATION

Name:

Company:

Phone:

SELLING AGENT INFORMATION

Name:

Company:

Phone:

OTHER INFORMATION

Estimated Closing Date:

(mm/dd/yy)

Please fax a copy of the Sales Contract, Will, Death Certificate and/or Divorce Decree, if applicable,
and prior Owners Title Policy in order to receive a potential reissue credit to (615) 269-7675

Special Instructions or Requirements: