State Line Abstract, Inc.

TITLE INSURANCE ORDER FORM

TYPE OF SEARCH

Purchase

Refinance

Search Only (no insurance)

PROPERTY ADDRESS

Street Address
Township	County
Lot Number	Block Number
Owners / Sellers

SELLER

Seller's Status	Seller's Marital Status	Seller's Social Security Number
Husband / Wife Corporation Partnership Limited Partnership Limited Liability company (LLC) Estate Other	Single Married Divorced Widow(er)
Seller's current mortgage lender	Current lender's phone no. and mortgage account number
Seller/Owner's phone

BUYERS / BORROWERS

Buyers / Borrowers name (complete names with middle initial)	Buyers / Borrowers status
	Husband / Wife Corporation Partnership Limited Partnership Limited Liability Company (LLC) Estate Other
Buyer's current Mortgage lender	Current lender's phone no. and mortgage account number
Buyer's / Borrower's Social Security Number	Buyers current mailing address
Purchaser / Borrower's phone

NEW MORTGAGE LENDER

Lender's Phone	Lender's Fax
Lender's Name	Lender's Address
Contact Person

Purchase Price	Mortgage Loan Amount	Requested Settlement Date

Send copies of commitment / search results to	Additional searches / services requested
	Order Survey Order Termite Order Flood Search Order Tax Search Order Corp. Good Standing Cert. Appraisal Other (specify)