Attorneys' Title Agency of Northwest Ohio, Inc.
Block Six Business Center
419 Fifth Street, Suite 2000
Defiance, Ohio 43512
Phone: 419-782-0363
FAX: 419-782-1758

To place an order with Attorneys' Title Agency of Northwest Ohio. Inc.;
choose one of the following methods:

1.) fill out the form below and submit it electronically
2.) print this page and fax information to 419-782-1758
3.) print this page and mail information
4.) phone 419-782-0363 to place verbally

Service Requested By: (your name)

Todays Date:

Company Requesting Services:

Company Street Address:

City, State, & Zip:

E-mail address:

Company Phone Number:

Company fax Number:

No order for title or escrow services placed electronically or by fax should be considered to be accepted until written confirmation has been returned by Attorneys' Title. If such confirmation has not been received within forty-eight (48) hours, please call 419-782-0363.

Requested Services

Title Escrow Title & Closing

Type of Title Evidence Needed:

Owners Policy?
Mortgage Policy?
Guaranteed Certificate?
Legal Description Available?	Yes No
Location Survey Needed?	Yes No
Refinance?	Yes No
Construction Loan?	Yes No

If Legal Description is Available, Please Provide.

Property Information:

Owner:
Address:
City:
State:
Zip:
County:
Parcel Number:
Selling Price:

Buyer Information:

Name:
Address:
City:
State:
Zip:
Telephone Number:
Fax Number:

Lender Information:

Company:
Loan Originator:
E-Mail Address:
Address:
City:
State:
Zip:
Loan Amount:
Requested Closing Date:

SPECIAL INSTRUCTIONS & NOTES:

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