Territorial Title of Las Vegas, Inc.

Online Order Form

NOTE: Move back and forth between fields using the Tab or (Shift)Tab keys.

Press ENTER key or click on "Place the Order" button to send information.

Client Details

Person Placing Order:

Company Name:

E-Mail:

Lender Details

Lender Name:

Address:

City, State, Zip:

Phone Number:

Fax Number:

Borrower/Buyer Details

Borrower Name (1):

Work Phone:

Borrower Name (2):

Work Phone:

Vesting Preference:

Address:

City, State, Zip:

Home Phone:

 

Cell Phone:

 

Cell Phone:

Seller Details

Seller Name (1):

Work Phone:

Seller Name (2):

Work Phone:

Vesting Preference:

Address:

City, State, Zip:

Home Phone:

 

Cell Phone:

 

Cell Phone:

Property Details

Legal Description of Property:

 

 

 

Property Street Address:

City, State, Zip:

Current Owner:

 

Transaction Details

Transaction Type:

Loan Amount:

Transaction Closing at Territorial Title?

Closing Date:

Do we need to order a payoff?

Existing Loans to be paid off:

(Please list lender name and

loan number)

Do we need to order a survey?

Do you require a Closing Protection Letter?

Other Comments:

Yes:   No:

Yes:   No:     (If yes, Borrower Authorization Required)

1)

2)

3)

Yes:   No:

Yes:   No:     (If yes, Lender's Address Required)

Mortgagee's Policy     Owner's Policy

Sales Price: $ 

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