CONTACT NAME:_________________________________________________________________________________________
CONTACT ADDRESS:____________________________________________________________________________________________
_________________________________________________________________________________________________________
CONTACT TEL:______________________________________ CONTACT FAX:_________________________________________
Record Owner:______________________________________________________________________________________________
Purchaser:___________________________________________ Marital Status: Yes____ No:____
Property Address:___________________________________________________________________________________________
Municipality:__________________________________________ County:_______________________________________________
Lot:______________________ Block:__________________________ Unit:_______________________ Bldg:________________
Purchase Price:____________________ Loan Amount:____________________ Mortgagee:________________________________
Prepare Notice of Settlement: Yes:____ No:____ File Notice of Settlement: Yes____ No:____
Order Survey: Yes:____ No:____ With Stakes:____ Without Stakes:____
SEND COPY TO SELLERS ATTORNEY / LENDER
Sellers Attorneys Name:____________________________________________________________
Address____________________________________________________________________________________________________
___________________________________________________________________________________________________________
Phone:____________________________________________ Fax:____________________________________________________
Lenders Name:___________________________________________________________________
Address:____________________________________________________________________________________________________
___________________________________________________________________________________________________________
Phone:____________________________________________ Fax:_____________________________________________________
Date Requested:__________________________________ Proposed Closing Date:_________________________________________
Comments / Special Instructions:__________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
NATIONWIDE TITLE AGENCY
Tel: 609.978.0019
Fax: 609.978.0910
www.ntacorp.com
FAX ORDER TO 609.978.0910
Thank you for your Business
