TITLE INSURANCE ORDER FORM

TITLE INSURANCE ORDER FORM
Atlantic Title & Settlement Service, LLC
130 Clinton Rd. Suite201. Lobby A. Fairfield, NJ 07004

Office: 973-575-4848 Juanita's Direct: 732-895-3196

PLEASE EMAIL THIS ORDER FORM DIRECTLY TO JUANITA DRYER AT JDRYER@ATLANTICTITLE.NET
Attorney Phone Number:
ATTORNEY Name:
Attorney Fax:
Attorney Email:
example@example.com
Today's Date:

Month Day Year
Date
Due Date:

Month Day Year
Date
Closing Date:

Month Day Year
Date
SELLER Name:
BUYER Name:
(please specify how buyers will hold title)
PREMISES:
Municipality:
County:
Lot:
Block:
HOA (Yes/No)
Street Address:
LENDER Name:
LENDER Contact:
LENDER Phone:
LENDER Fax:
LENDER Email:
example@example.com
Purchase Price:
Mortgage Amount:
Atlantic Title to order survey. Please provide the name of the surveyor if you have a preference. (Yes/No)
Attorney to order survey. (Yes/No)
Atlantic Title to file Notice of Settlement: Yes/No
Delivery method of binder: Regular mail / Email / Both
SETTLEMENT SERVICES REQUIRED (Yes/No)
DO NOT INCLUDE SETTLEMENT SERVICES (Yes/No)
***IF SETTLEMENT SERVICES ARE REQUIRED, PLEASE PROVIDE A LEGIBLE COPY OF THE CONTRACT OF SALE AT THIS TIME**
Send copy to Seller's Attorney Name:
Send copy to Seller's Attorney Email:
Send copy to Buyer Realtor Name:
Send copy to Buyer Realtor Email:
Should be Empty:

PREMISES: