VALLEY LAND TITLE COMPANY, INC.


Telephone    918-775-4872     FAX 918-775-4812     Email: closing@vltitle.com

ORDER FORM

PURCHASE ___ REFINANCE ___ CONSTRUCTION ___ OTHER ___

LENDER

Lender Name: __________________________ Address: _________________________________
Loan Officer: ___________________________ Telephone/Email: __________________________
Loan Amount: ___________________________

PROPERTY

Property Address: __________________________________________________________
Legal Description: _________________________________________________________

BUYER/BORROWER

Buyer(s) Name: _______________________________________ Marital Status: _______________
Buyer(s) Address, Phone, Email: ______________________________________________________

SELLER

Seller(s) Name: _______________________________________ Marital Status: _______________
Seller(s) Address, Phone, Email: ______________________________________________________

REALTOR

Buyer(s) Realtor: ________________________ Seller(s) Realtor: _______________________
Commission: ________________________        Commission: _______________________
Address, Phone, Email: ______________________ Address, Phone, Email: __________________
_________________________________________ ______________________________________

OTHER

Please send copy of sales contract:
Location of Abstract: _________________________ Bring to Date _______ Title Report _________
Termite: Yes __ No __ Survey: Yes __ No __
Other information, comments: __________________________________________________________
___________________________________________________________________________________

Signature of person placing order: ________________________________