AFFILIATED TITLE OF MARION COUNTY, LTD
2701 SE MARICAMP RD. SUITE 1, OCALA, FL 34471
PH: 352-369-4300 FAX: 352-369-4305
EMAIL: Affiliated@AffiliatedTitle.net
Preferred closer: Becky Michelle Donna Jennifer (Circle One)
Order date: ___________________ Proposed closing date:_____________
Order by: _____________________ Company: _______________________
Phone: ______________________ Fax: ___________________________
Property:
SALES PRICE: $__________________
Legal Description: Lot: _______ Block: ______ Subdivision: _______________________
Parcel ID #: _____________________ Address: _________________________________
Homeowner Assn.: Yes / No (circle one)
Contact Name: ________________________________ Phone: ________________
Mobile Home: Singlewide Doublewide Triple Wide (Circle One)
Year: ____________ Make: _________________ Model: __________________________
ID #(s): ___________________________________________________________________
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Seller Mail Out? Yes No (Circle One)
Name: _____________________________________
_____________________________________ H&W Single (Circle One)
Address: ___________________________________________________________
Phone: ____________________________ Email: _______________________
Social Security #(s): __________________________________________________
Realtor Name: _______________________ Company: _____________________
Phone: _____________________________ Fax: _________________________
Email: ______________________________________________________________
Prior Policy Attached? Yes No (Circle One)
Existing liens to be paid: Lender Name: _______________________________
Account #: ___________________________ Phone #: ___________________
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Buyer Mail Out? Yes No (Circle One)
Name(s): ___________________________________________
___________________________________________ H&W Single (Circle One)
Address: ______________________________________________________
Phone: ___________________________ Email: ____________________
Social Security #(s): _____________________________________________
Realtor Name: _______________________ Company: ____________________
Phone: _____________________________ Fax: _________________________
Email: _____________________________________________________________
Lender Name: _______________________________________________________
Contact Person: _____________________________________________________
Phone: _________________________ Fax: ___________________________
Email: _____________________________________________________________
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Loan Amount: _____________________ Loan Type: ____________________
Earnest Money Deposit $ ____________ Held by:_______________________
Commission: Listing: _______________ Selling: ________________________
Transaction Fee? Amount: $_________ To:___________________________
AFFILIATED TITLE DOES NOT ORDER SURVEYS OR INSPECTIONS
