Fidelity Land Title, LTD.
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Fidelity Land Office
Fidelity Land Office
Fidelity Land Office
Fidelity Land Office
Fidelity Land Office
Fidelity Land Office
Fidelity Land Office

This form will also serve as your order for Title Insurance.
(* marks a required field)
*Broker:
*E-mail:
Property Address:
City:
State:
Zip:


Sale Price:
Listing Agent:
Company:
Phone:

Selling Agent:
Company:
Phone:
Sale Price:

Referral:
Commission:
Co-Broke Office:
Commission Split:
Closing Date:
Time:
Place:

FIDELITY to cut checks and attend closing:
Bill for Closing Statement:

If Seller has mortgage(s) against property - PLEASE PROVIDE (from payment coupon):
Lender Name:
Lender Address:
City:
State:
Zip:
Loan Account Number:
Phone Number:

Lender Name:
Lender Address:
City:
State:
Zip:
Loan Account Number:
Phone Number:

Lender Name:
Lender Address:
City:
State:
Zip:
Loan Account Number:
Phone Number:

SELLERS:
Name:
S.S.#:
Address (if different from property being sold):
City:
State:
Zip:
Phone:
Attorney:
Will attorney prepare deed:

Name:
S.S.#:
Address (if different from property being sold):
City:
State:
Zip:
Phone:

BUYERS:
Name:
S.S.#:
Address:
City:
State:
Zip:
Phone:
Attorney:

Name:
S.S.#:
Address:
City:
State:
Zip:
Phone:
Attorney:

OFFER TO PURCHASE INFORMATION:
Date of Offer:
Date of Acceptance:
Earnest Money Amount:
Date Due:
Date Received:

GAP COVERAGE:
ADDITIONAL BILLS:
Fuel Oil/LP Gas Reading: Gallons
$Per Gallon:
Purchased From:
Home Owner Protection Plan:
Cost:
Paid To:
Rent per Month (if applicable):
Date Due:
Last Paid:
Security Deposit to be transferred:
Rent per Month (if applicable):
Date Due:
Last Paid:
Security Deposit to be transferred:

Miscellaneous Bills:
Amount:
Paid To:
Amount:
Paid To:
Amount:
Paid To:

CLOSING INFORMATION:
Lender:
Address:
City:
State:
Zip:
Loan Officer:
Phone:
Fax:

Closing Agent:
Phone:
Fax:


Copies of title commitment should be sent to:

IF ORDER DEED/TRANSFER FORM/AFFIDAVIT DOCUMENTS PLEASE COMPLETE THE FOLLOWING:

Does the seller have attorney representation?
If so, whom?
If not, who would you like to draft
Deed/Transfer Form/Owners Affidavit:

Please provide the following information for the documents to be drafted:

Documents needed by:



Address:
City:
State:
Zip:


Seller's NEW Address:
City:
State:
Zip:


Buyers wish to hold title as:



Is property seller's homestead?:


Is DLHR required?:


Is there any relationship
between seller and buyer?:
Type of Property:


Primary Use?:


Additional Comments:


Please provide our office with a copy of the Offer to Purchase.

   

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