TITLE SERVICES REQUEST FORM FOR
REAL ESTATE AGENTS AND PRIVATE SELLERS


Your Email Address:

From:

Phone: Fax:

Contact Person:

Property Address:

County: Legal Attached:


Seller Information

Seller(s) Name:

Marital Status: Spouse's Name:

Seller(s) Address:

Seller(s) Phone: (H) (W)

Seller(s) SS#

Listing Reality Company:

Phone: Fax:

Listing Realtor:

Current Mortgage/Lien Holders:  (1st)

Account #

Phone: Fax:

(2nd) Account #

Phone: Fax:


Buyer Information

Buyer(s) Name:

Marital Status:

Current Address:

City: State: Zip:

Phone: Buyer(s) SS#

Hazard Insurance Information:

Selling Realty Company:

Phone: Fax:

Selling Realtor: Phone:

Proposed Closing Date:

Special Instructions:



Feel free to email us if you have any questions or comments at info@acsknoxtitle.com
ACS Title and Closing, 109 East High Street, Mount Vernon, Ohio 43050
(740) 393-7777 Toll Free: 1-866-393-7773
Facsimile: (740) 392-2365