Title Request Form

Request for title commitment.

Part I - Request

1. Date:

2. To:

Perrie & Associates, LLC
(P) 770-953-0826 / (F) 404-214-6674
Galleria
West Cobb
Keller Williams - Smyrna

* 3. From
Name:
Address:
City/State/Zip:
Phone/Fax:
Email:

* 4. Name and Address of Applicant
Name:
Address:
City/State/Zip:

* 5. Phone:

* 6. Social Security Number:

7. Date of Birth:

* 8. Email Address:

9. Occupancy Status
Primary Residence
Second Home
Investment Property

*10. Loan Purpose
Purchase
Refinance
SS Purchase

11. Sales Price:

*12. Loan Amount:

*13. Property Address:
Street:
City:
State:
Zip:
County:

*14. Mortgagee Clause:
Lender Loan #

15. Estimated Closing Date:

*16. Are all parties on the current Deed attending the closing:
YES
NO
If NO, please explain: