Milwaukee Title, Inc. ™

TITLE INSURANCE APPLICATION

Please provide the following information:

Customer Name

Attention

Address

Address (cont.)

City

State

Zip

Country

Phone

FAX

E-mail

ORDER TYPE:

Owners Policy			$

Junior Policy			$

Letter Report			$

Mortgage Refinance		$

Closing Service		$

Other  			$

STATUS:

Order date

-- mm/dd/yy

Need date

-- mm/dd/yy

Search & Hold

-- mm/dd/yy

Tentative closing date

-- mm/dd/yy

PROPERTY:

Street Address

Address (cont.)

Municipality

Tax Key #

Seller/TVI:

Buyer(s):

Lender:

Would you like additional copies? (Enter recipients below)

Yes No

SPECIAL SERVICES:

Legal on TF &      Deed               Special            Tax Bill         
Water Status       Escrow Inspection  Other (specify)

PRIOR TITLE:

Company:

To:

Pick-up
Fax
Mailed To

Special Instructions:

Click button to skip to the end of this form

ADDITIONAL COPIES:

Additional Copy 1 to:

Name

Address

Address (cont.)

City

State

Zip

Copies

Phone

FAX

URL

Additional Copy 2 to:

Name

Address

Address (cont.)

City

State

Zip

Copies

Phone

FAX

URL

Additional Copy 3 to:

Name

Address

Address (cont.)

City

State

Zip

Copies

Phone

FAX

URL

Additional Copy 4 to:

Name

Address

Address (cont.)

City

State

Zip

Copies

Phone

FAX

URL

Additional Copy 5 to:

Name

Address

Address (cont.)

City

State

Zip

Copies

Phone

FAX

URL

Additional Copy 6 to:

Name

Address

Address (cont.)

City

State

Zip

Copies

Phone

FAX

URL

Form Completed