Title Insurance Order Form Today's date: Nov 20, 2008 4:40 pm US/Eastern (Note: Orders received after 3pm E.S.T. (15:00:00) are considered next business day) This Request is from: Company Name: Requester's Name: Address: City: State: Zip Code: Phone: Fax: E-Mail: Charge To (if different from above): Property Information Buyer's Name(s): Owner's Name(s): Property location: City/Town/Village: County: SBL#: Deed Information (if available): Liber Page(s) Recorded Services Requested Fee/Owner's policy Loan/Mortgage policy Simultaneous policy Leaseholder policy Endorsements Required (please select all that apply): Residential mortgage Waiver of arbitration Environmental protection lien Survey Other: Purchase Amount: Annual Rent: Mortgage Amount: Please select one Regular Building loan Fixed Variable Lender Name: Mortgagee clause: Abstract Information (company name & abstract number): To follow: Copy of mortgage commitment Survey Proposed deed Lender Attorney Name Lender Attorney Address: Lender Attorney City Lender Attorney Zip Code Seller Attorney Name Seller Attorney Address: Seller Attorney City Seller Attorney Zip Code Delivery instructions: Please select as many options as needed and provide address information. Original title report Copy of title report Additional information Comments