Date:  

Name/Company: 

Address: 

Phone:    Fax:    Email:  

Please check one:     SALE/PURCHASE          REFINANCE            LINE OF CREDIT

Property Address:  

City/Township:    County:    Parcel No.:  

Please check one:  Single Family Residence    Multi-Family Residence    Condo    Commercial

Seller's Full Name(s):                    

(as it appears on Deed)    SS#:  SS#: 

Is the Seller Deceased?: yes      no

If yes, please provide:   Date of Death:    Will # or Administration #:  

Buyer's Full Name(s):                    

(as it will show on Title)   SS#:  SS#: 

Sale Price:  $     Loan Amount:  $

Mortgage Company: 

Address: 

Contact:    Phone:   Fax: 

Are there any Mortgages being paid off?:        yes         no

If yes, please provide the following information for each loan being paid off:

Mortgage Co.:    Phone:    Loan #:  

Mortgage Co.:    Phone:    Loan #:  

For Sales in Philadelphia, would you like Executive Abstract to order the U&O Cert?:   yes        no

For Sales in New Jersey, is a SURVEY required?

    yes, I would like E.A. to order the Survey     yes, I will be ordering the Survey     no Survey required

For Sales in New Jersey, who will be preparing the Deed?

Name/Company:    Phone:    Fax #:  

Are there any Co-ops involved, Attorneys or anyone else we should send the Title to?  If so, please list:

Name/Company:    Phone:    Fax #:  

Name/Company:    Phone:    Fax #:  

Estimate Settlement Date:     (NOTE: Estimate date only – this does not schedule settlement.)

Any additional instructions: