1133 W.Glen Avenue
Peoria Illinois 61614
Phone: 309-676-8855
Fax: 309-676-8955
CustomerService@
countytitle.com
You are not required to fill out this form.
We are happy to hear from our customers in person.
Preparer's Information
Email Address
(required)
Property Information
Prior Title Policy Sent With Order
Yes
No
County
Street Address
City
State
Zip
Brief Legal
Parcel ID
Property Type
Single Family
Condo
Duplex
Vacant Lot
Commercial
Sale Price
Commission
Earnest Money
Possession Date
Deed Preparation by
Seller Information
Name(s)
SS#
Current Address
Forwarding Address
Marital Status
Single
Married
Divorced
Widow
Attorney
Listing Realtor
Name
Company
Phone
Fax
Buyer Information
Name(s)
Current Address
Property to be Owner Occupied?
Yes
No
Marital Status
Single
Married
Divorced
Widow
Taking Title As
Solely
Tenants in Common
Joint Tenants
Tenants by the Entirety
Attorney
Selling Realtor
Name
Company
Phone
Fax
Lender
Company
Loan Officer
Phone
Fax
Copies Of
The Title Work
Will Be Sent To
Listing Realtor
Selling Realtor
Lender (If Any)
Attorneys (If Any)
Comments
© 2004 County Title Company
