Custer Title Company

Title Ins Order Form

Date Ordered
Contact Information:
Name
Business
Address
Phone
Fax
Email
O & E Report	Yes: No:
Owners's Policy	Yes: No:
Owners Policy Amount
Lender's Policy	Yes: No:
Lender's Policy Amount
Standard Coverage	Yes: No:
Extended Coverage (8.1 & 9.0 Endorsements)	Yes: No:
Other Endorsements Requested
Lender
Refinance	Yes: No:
Construction	Yes: No:
Permantent Loan	Yes: No:
Property Type	Residence: Bare Land: Commercial:
Property Type	Improved: Unimproved:
Any Improvements within the last year?	Yes: No:
Property Address
Legal Description (required)
Present Owner/Seller
Address
Phone
SS#	/ SS#:
Buyer
Address
Phone
Prior title Evidence (if any)	Yes: No:
Prior Title Policy #

Listing Agent
Email Address
Phone Number
Fax Number

Selling Agent
Email Address
Phone Number
Fax Number
Additional Copies to:
Closing at Southern Hills Title?	Yes: No:
Projected Closing Date
Please complete the Closing Order Form if Closing with Southern Hills Title