Charlevoix Abstract & Title Agency
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Order for Title Work

From (Bill to): Date:
Company: Need by:
Address: Phone:
City, State, Zip: Fax:
Email: P.A. Attached Pages
Check all that apply:    
1) The person/company ordering this is: 2) Please provide me with the following:
Listing Agent
Selling Agent
Mtg. Broker
Title Search Preliminary Commitment
Owners Policy $
Lenders Policy $
Refinance $
Other: Earnest Money Dep.
Closing Date (or TBD)
3) Buyer(s)/Borrower(s): 4) Seller(s)/Current Owners:
Name: Name:
Address: Address:
City, State, Zip: City, State, Zip:
5) Lender to be shown on title work:
Same as billing Other  
Address: Phone:
City, State, Zip: Fax:
Send title work to billing address Send copy to:
Previous Title Work (please submit with order for re-issue credit)
Legal Description/Tax ID No.



203 Mason Street • Charlevoix, MI 49720 • Phone: 231-547-0792 • Fax: 844-274-2157 • Email:
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