Title Report Order Form - Title West : Utah Title Services Company, 1031 Exchange

What County is your property located in? Services Requested

Transaction Information

Please Note: Transaction information only applies to the Foreclosure/Litigation Report and the Commitment for Title Insurance.

Transaction Type: Sales Price: Loan Amount: Endorsements:

Property Information Address: * City: * State: * Zip: * Parcel Number: Legal Description:

First Mortgage Holder Full Name: Phone Number: Loan Number:

Second Mortgage Holder Full Name: Phone Number: Loan Number: Is there a Condo, HOA or Management Contact:

Seller Full Names(s): * Address: City, State, Zip: Phone: Office Phone: Email:

Buyer Full Names(s): * Address: City, State, Zip: Phone: Office Phone: Email:

Request By Full Names(s): * Company: Address: City, State, Zip: Phone: Fax: Email:

Buying Agent Full Names: Company: Address: City, State, Zip: Phone: Fax: Email:

Lender Information Company Name: Officer's Name: Address: City, State, Zip: Phone: Fax: Email:

Who is your Escrow Officer? Special Instructions:

The information contained herein is provided from the Company's records and is not the result of a title search or based upon a complete examination of the public records. No representation is made as to the sufficiency of this information for any specific purpose and should not be relied upon as the basis for any tranaction affecting title to the subject property. TITLE WEST hereby disclaims any and all liability for the validity, sufficiency and/or effect of any documents or information contained herein.

Title West Title Company

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