Frick Powell, LLP
Title Services Order Form
Please fill in the fields for all applicable information
* indicates required field

Current Date & Time:    5/11/2008 9:12:21 PM
PERSON PLACING ORDER
* Name: * Company:
* Phone: Fax:
Email:    
PROPERTY INFORMATION
* Street Address of
Subject Real Estate:
* City, State, Zip of
Subject Real Estate:
Short Legal Description:
* Seller / Owner:
Purchaser:
Purchase Price:
* Lender:
* Loan Amount:
SERVICE REQUESTED
Property Search Report (Short Search)  
Title Insurance Mortgage Policy   Owner's Policy
Deed Preparation  
Sales Disclosure Form Preparation  
Closing Services  
OTHER
Abstract or Prior Title Policy Located at:
Please provide name of current mortagage lender, account number, and servicing phone number for ALL open mortgages:
Special Remarks, Instructions, or Unusual Circumstances
Please Attach Purchase Agreement:

If Purchase Agreement Not Available
How title is to be vested:
Purchasers will assume taxes Payable:

CONTACT INFORMATION
Frick Powell, LLP
223 S.E. Second Street, Evansville, IN 47713
Phone: 812-426-6788 Fax: 812-426-6792
Closing Contacts:
Stacy Wagner - 812-426-6788 / stacyw@frickpowell.com

Jennifer Beard - 812-425-4687 ext. 307 / jenniferb@frickpowell.com

Garland W. Cravens, Jr. - 812-425-4687 ext. 305 / garlandc@frickpowell.com