Title Insurance Request Form Type of Loan * Refinance Purchace 1st Borrower 2nd Borrower Borrower's First Name * Borrower's Middle Initial Borrower's Last Name * Borrower's Date of Birth * Borrower's Social Security Enter last 4 digits only 2nd Borrower's First Name 2nd Borrower's Middle Initial 2nd Borrower's Last Name 2nd Borrower's Date of Birth 2nd Borrower's Social Security Enter last 4 digits only Property Address Property Address * Property City Property Zip * Deed Book Volume Page Tax ID Number Property Address (Con't) Property State Party Requesting Title Party Name * Party Address * Party City Party Zip * Party Phone * Party FAX Party Email Party Address (Con't) Party State Loan Information Loan Amount * Lender * If Purchase Sales Price Seller's Name Seller's Social Security Enter last 4 digits only Please fax or email us a copy of the Sales Agreement Fax number: (412) 486-8300 Email: info@west-legal.com Realtors Seller's Agents Name Seller's Agents Phone Seller's Agents FAX Buyer's Agents Name Buyer's Agents Phone Buyer's Agents FAX Notes/Comments Submit Order Form
