Fax From: ___________________________________
Address: ___________________________________
___________________________________
Tel #: __________________Fax #________________
email address: ________________________________
Applicant’s File # ____________________________
TO: MOORE TITLE SERVICES , INC., 272 Parsippany Road, Parsippany, NJ 07054 Telephone #: (800) 734-6019 Fax #: (973) 560-0819
1) Type of Transaction: q Purchase q Present Owner Title Search Report
q Refinance ( no insurance required) q Subordinate Mortgage q Other (please specify in detail below) ________________________
2) Owner’s Policy: $___________________Loan Policy: $ _______________
3) Names of Owner(s) of Premises: ________________________________
______________________________________________________________
4) Names of Purchaser(s)/ Borrower(s) of Premises:
__________________________________________
__________________________________________
5) Name of Lender ( if applicable):_________________________________ _____________________________________, its successors and/or assigns, atima
6) Lender Address:____________________________________________
_____________________________________________________
7) Property Address: _____________________________________________________
8) Town/ Borough: _______________________County:______________ State:___________
9) Tax Block: ______________Tax Lot : ________________ Tax Section (NY):_____________
10) Order Tax & Assessment Search: qYes q No
11) Order Flood Zone Search Certificate: q Yes q No
12) Order Survey ( or Survey Certificate [condo]): q Yes q No q To Advise
13) Prior Title Insurance Policy available : q Yes (attach copy) q No
14) Required Policy Endorsements: __________________________________________________
15) Comments: ____________________________________________________________________