Services Requested & Property Information

(select as many as apply)

SettlementTitle InsuranceSettlement & Title Insurance

Type of Policy:

Owners Purchase Price $
Mortgage Amount $
Other 

Type of Transaction:

Refinance/New LoanRefinance/AssignmentPurchase/New Loan
Purchase/Cash     Secondary Loan      Building Loan

---

Buyer/Borrower:
Phone #:
Address:
Buyer/BorrowerAttorneys:
Firm Name:
Address:
Phone #:
Fax:
E-Mail Address:

---

Seller:
Phone #:
Address:
Seller'sAttorney:
Firm Name:
Address:
Phone #:
Fax:
E-Mail Address:

---

Lender:
Phone #:
Address:
Lenders Atty Settlement Agent:
Firm Name:
Address:
Phone #:
Fax:
E-Mail Address:

---

Property Address:
Tax Code:
Legal Description:
Deed Book:
Deed Page:

Please Check One:

New ConstructionExistingVacant Land

	LENDER NAME	LOAN #	PHONE#	CONTACT NAME
Pay-off existing Lender
Assign Existing Mortgage
New Loan

	Name	Phone #
Listing Agent:
Selling Agent:
Loan Officer:
Insurance Agent:

Homeowners Association transfer:YesNo

Estimated Closing Date:
Need Commitment by:
Comments/Remarks:

QUESTIONS:kford@nytitle.com

NewYork Title

550 Mamaroneck Avenue, Suite 401

Harrison, New York 10528

(914)-835-7100

FAX:914-835-7466

E-mail:kford@nytitle.com

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