NIA/Lawyers Title Agency, LLC printable form

Date Ordered: Commitment Date: Case No:

Applicant:
Company/Firm:
Phone:
Email:
Address: City: State:
Zip:

Property Address:
Street:
Lot:
Block:
Municipality: County:
Condo: Unit No.: Bldg:

Present Owner:
Marital Satus:
Maiden Name:
Phone:
Address: City: State:
Zip:
Fax:
Email:

Buyers/Mortgagors:
Purchase $:
Marital Satus:
Maiden Name:
Phone:
Address: City: State:
Zip:
Fax:
Email:

Lender:
Contact:
Address:
Phone:
Fax:
E-Mail:
Mortgage $

Survey: NIA Attorney Affidavit Waived TBA

Flood: Yes No Life of Loan

Sellers Attorney:

Prior Title Information:

Comments: