Title Insurance Request

 

To:

Olmsted & Wilson, P.A.
17801 Murdock Circle, Suite A
Port Charlotte, FL 33948
Phone: 941-624-2700
Fax: 941-624-5151 		From:
  Phone:
Fax:
Email:

Buyer/Seller Information

 
Buyer  
   
Name:
Address:
   
Phone (Home):
Phone (Work):
   
Marital Status
   
Closing:
   
How title is to be taken:
   
Seller  
   
Name:
Address:
   
Phone (Home):
Phone (Work):
   
Marital Status
   
Closing:
   
Address for Deed:
   

 

Description of Property

 
   
Lot(s):
Block:
Section:
Subdivision:
Plat Book:
Page:
   
Condominium:
Unit No.:
Carport (Garage) No.:
   
Tax ID No.
   
Acreage Fax a copy of metes and bounds description to our office
   
Mobile Home Fax a copy of Title/Registration/R.P. Sticker, if applicable. to our office.
   
Status of Property:

 

Sales Information

 
   
Closing Date:
Purchase Price:
Deposit:
Deposit held by:
New Loan:
   
Lender Information
   
Lender:
Phone No.:
Contact:
   
Existing Loan To Be Paid Off
   
Lender:
Phone No.:
Social Security No.:
Account#:
   
Title Insurance
   
Please fax a copy of prior title policy, if available, to determine if reissue rate applies.
   
Realtor's Commission
   
Broker:
%
Payable to whom:
   
Co-Broker:
%
Payable to whom:
Contact Name:
Contact No.:
   

 

Miscellaneous Information

 
Termite Inspection Report By:
Charge:
   
Survey By:
Charge:
   
   
 
   

 
 

 

© 2005 Olmsted & Wilson, P.A. All rights reserved.
17801 Murdock Circle, Suite A, Port Charlotte, FL 33948 Phone: 941.624.2700 Fax: 941.624.5151
 
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