Peoria Title, LLC

Title Request Form For Sale/Purchase

Closing Location*
Sellers
Seller's Legal Name*
First Last
Second Seller's Legal Name
First Last
Seller's Phone*
Forwarding Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Marital Status*
- Single
- Married
- Divorced
- Widowed
Another party in the title deceased?*
- Yes
- No
Name of deceased*
First Last
Buyer(s)
Buyer's Legal Name*
First Last
Second Buyer's Legal Name
First Last
Buyer's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Buyer's Phone
Will this be the Buyer's Principal Residence?*
- Yes
- No
Buyer's Marital Status?*
- Single
- Married
- Divorced
- Widowed
Address of Property (Or Legal Description)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Tax I.D. Number(s)*
Is more than 1 parcel being transferred?*
- Yes
- No
Purchase Price*
Earnest Money*
Total Commission (%)*
Split?*
- Yes
- No
Closing Date*
MM
DD
YYYY
Possession Date*
MM
DD
YYYY
Do you need a deed, green sheet, etc?*
- Yes
- No
How will the title be held?*
Contract and Prior Titlework Attached*
- Yes
- No
Contact and Prior Titlework Upload*
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx.
Copies of Commitment to
Seller Realtor
Seller Realtor*
First Last
Seller Realtor Company*
Seller Realtor Phone*
Seller Realtor Fax*
Seller Realtor Email*
Buyer Realtor
Buyer Realtor*
First Last
Buyer Realtor Company*
Buyer Realtor Phone*
Buyer Realtor Fax*
Buyer Realtor Email*
Lender
Lender*
Loan Officer*
First Last
Lender Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Lender Phone*
Lender Fax
Lender Email*
Notes, Comments, or Special Instructions
Email to send Form Copy to*
Captcha
Comments
This field is for validation purposes and should be left unchanged.

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Title Request Form For Sale/Purchase

Sellers

Buyer(s)

Copies of Commitment to

Seller Realtor

Buyer Realtor

Lender