Getty Midwest - - Title Insurance Order Form - Minnehaha & Lincoln Counties

Order for Property Located In: *

Minnehaha County: Lincoln County:

Ordered By

Company Name: *

Your Name: *

Branch or Office: *

Loan or Ref No.:

Phone Number:

Fax Number:

Email: *

General Information and Services Requested:

Owner's Policy:	Sale Price / Policy Amount: *	$.00
Loan Policy:	Mortgage Amount: *	$.00
Loan Refinance Policy:	Mortgage Amount: *	$.00
Construction Commitment:	Mortgage Amount: *	$.00
Jr. Loan Policy:	Mortgage Amount: *	$.00

Mortgagee's Name(s) if different
than Company Name above:

Date Needed:

select

Closing Date:

select

Closing at Getty:

Yes: No:

Getty to Order Survey:

Yes: No:

Staked Survey:

Yes: No:

Surveyor Preference:

Surveys ordered on your behalf will be billed to you. As a condition of ordering a survey we assume no liability for the expense incurred and will make this known to the Surveyor when the order is placed.

Property Information:

Street Address:

City:

State:

Zip:

Tax Parcel Number:

Legal Description:

Name of 1st Buyer:
Mortgator (Refi.)

Name of 2nd Buyer:
Mortgator (Refi.)

Current Address:

City:

State:

Zip:

Name of 1st Seller:

Name of 2nd Seller:

Listing Realtor:

Selling Realtor:

Comments:

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