Buy/Sell/Purchase Form

Buy/Sell/Purchase Form

Please fill out the following information to buy / sell / purchase.(*indicates required fields)
If you do not receive a confirmation within 24 hours, please email orders@actil.net.
Needed by date

MonthDayYear
Ordered by info
Name*

First NameLast Name
Company
Phone Number*
Fax
Primary Email*
Secondary Email (if applicable)
Sales price / owners policy amount*
Buyer info:
Buyer's Name 1*

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Buyer's Name 2 (if applicable)

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Seller info:
Seller's Name 1*

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Seller's Name 2 (if applicable)

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Lender info:
Company:
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Lender Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Loan amount
Property information:
Address*
Address 2
City*
County*
State*
Zip code*
Lot size or condo square footage
Property Identification Number (or tax ID number)
Short legal description
Property Type*

Residence / duplex 1-4Vacant land / lotNew construction with payoutNew construction without payoutResidentialCommercialOther
Type of commercial property (if applicable)
Prior title evidence to be provided?

YesNo
Listing agent / company:
Listing agent email:
Buyer's agent name:
Buyer's agent email:
Seller's attorney name:
Seller's attorney email:
Buyer's attorney name:
Buyer's attorney email:
Special Instructions
Please verify that you are human*
Should be Empty:

Buy/Sell/Purchase Form

If you do not receive a confirmation within 24 hours, please email orders@actil.net.

Ordered by info

Buyer info:

Seller info:

Lender info:

Property information: