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


Affiliated Title of Central Florida, Ltd.