Order Information
Order Date:
       
Closing Date:
       
Due Date:
       
Order By:
Company:
Phone:
Fax:
E-Mail:
Property
Address:
Address:
County:
City:
State:
Zip Code:
Tax ID:
Legal Description:
Transaction Information
Type of Transaction:
If "Other" specify
Sales Price:
$
Loan Amount:
$
Alliance Title to Process:
Alliance Title to Close:
Seller Information
Seller 1 Name:
SSN:
XXX-XX-
Seller 2 Name:
SSN:
XXX-XX-
Address 1:
Address 2:
City:
State:
Zip Code:
Phone:
Cell Phone:
E-Mail:
Buyer Information
Buyer 1 Name:
Buyer 2 Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Phone:
E-mail:
Title to be held:
Listing Agent Information
Company:
Company Phone:
Agent Name:
Phone:
Cell/VM:
Fax:
E-Mail:
Commission:
Listing Agent:
 Selling Agent:
%
 %
Total Commission:
Selling  Agent Information
Company:
Company Phone:
Agent Name:
Phone:
Cell/VM:
Fax:
E-mail:
Lender Information
Lender:
Financing Institution:
(Please state proposed insured exactly how  it will
show on title commitment)
Phone:
Fax Number:
Loan Originator:
Loan Processor:
Financing Type:
Seller Assistance:
Second Mortgage Information:
Existing Lien Information
Payoff 1
  
Mortgage Company:
Account Number:
Phone:
Payoff 2
  
Mortgage Company:
Account Number
Phone:
Special Instructions
"Our Customer service is... our best salesman"
ALLIANCE TITLE
&
SETTLEMENT SERVICES, INC
513 MCKINLEY
MISHAWAKA IN 46544

PHONE:             1.888.202.0508
FAX:                     1.574.258.0509
E-MAIL                customers@alliancetitle1.com