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1133 W.Glen Avenue
Peoria Illinois 61614
Phone: 309-676-8855
Fax: 309-676-8955

CustomerService@
countytitle.com

       
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Preparer's Information
Email Address
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Borrower Information
Name(s)
Marital Status Single
Married
Divorced
Widow

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

Policy Information
Loan Amount
Title Policy Amount Full Amount of loan requested
Minimum amount of $1,000.00
County Title Company to conduct closing? Yes
No

Lender
Company
Loan Officer
Phone
Fax

Loan Broker
Company
Contact
Phone
Fax

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