Bartech: Title Order Form

Applicant:

Name:

Address:

State:

Zip:

Phone:

E-mail:

Seller(s)/Owner(s):

Purchaser(s):

Premises:

Street Address:

Section:

Block:

Lot:

Purchase Price: $

Mortage Amount: $

Lender:

All normal department searches: Yes No

Survey Instructions:

Locate & Inspect
Locate & Advise
Order New
Instructions to Fallow
No Coverage Required
To be Provided (Order Inspection)

Check here if inspection is NOT required

NOTE: PLEASE MAIL HARD COPY OF SURVEY

REPORTS TO:

Sellers Attorney:

Name:

Address:

State:

Zip:

Phone:

E-mail:

Lenders Attorney:

Name:

Address:

State:

Zip:

Phone:

E-mail:

Other:

Name:

Address:

State:

Zip:

Phone:

E-mail: