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Application For Title Insurance — Purchase (dark blue fields are required)
Person Ordering Title:   Phone:   Date:
Sales Price:    Mortgage Amount 1st:    2nd:
Property Address:    City:    Zip:
Township:    County:    Parcel #:
Email Address (for confirmation email) :  
Propery Type:    Other:

Sellers:
  Name:
Social:
  Name:
Social:
  Name:
Social:
  Seller Address : Phone:
  Marital Status:

  • For estates please provide name and phone number of executor(s) and/or the Attorney for the Estate
  • If any of the original owners on the deed are deceased, please specify
  • If any divorces have occured please forward divorce decree & property settlement agreement
    Please submit any related notes:

Buyers - need full name as it will appear on title and mortgage:
  Name:
Gender:   Social:
  Name:
Gender:   Social:
  Name:
Gender:   Social:
  Buyer Address: Phone:
  Marital Status:   Tenancy:
  Please notify company immediately if buyer is married or separated and taking title without spouse

Mortage Company :
  Company Name:
  Address: Phone:
  Contact Person(s): Fax:
  Type of Mortgage:    Other:

Seller's Agent:
  Agent Name:   Conveyancer:
  Listing Office:
  Address:
  Phone:   Fax:
Buyer's Agent:
  Agent Name:   
  Selling Office:
  Address:
  Phone:   Fax:
  Preferred method of contact:     Contact Email:
  Attention:
Attorney (Buyer/Seller):
  Attorney Name:
  Address:
  Phone:   Fax:

GMSS to Order:   Tax Certificate   Sewer Certificate   Water Certificate   Payoffs

Payoff #1
  Mortgage Company:
  Phone # : Account # :

Payoff #2
  Mortgage Company:
  Phone # : Account # :

Settlement Date: Settlement Time:

Location of Settlement: 
Other (specify location):

Copyright 2006, Greater Montgomery Settlement Services