Western
Title
Phone: (308) 532-4500
Fax: (308) 532-4247
To send us an order, please fill out the form below. Processing will begin
promptly. Thank you.
* PLEASE USE CAPITAL LETTERS TO COMPLETE THE
FORM
Your Company Name:
Your
Name:
I
Need:
Transaction Type:
Purchase
Agreement Dated:
Buyer/Borrower:
Buyer/Borrower’s marital Status:
H&W
Jointly
H&W
TIC
Single
Present Address:
City, State, Zip:
Phone (Home):
Phone (Work):
Phone (Cell):
H SS#:
W SS#:
Purchasers Attorney:
Seller:
Status:
H&W
Single
Is Seller out of town requiring papers
to be mailed for signature:
Yes
No
Street Address:
City, State, Zip:
Phone (Home):
Phone (Work):
Phone (Cell):
H SS#:
W
SS#:
Present Lender:
Loan No:
Sellers Attorney:
Contract Sales Price:
$
Earnest Money: $
Held/Received By:
Property Address:
City:
State:
Zip:
County:
Check Type of
Property:
Residential
Commercial
Other
Listing Agent/Broker:
Selling Agent/Broker:
Total Commission Rate:
Advertising Fee:
$
Transaction Fee:
$
Home Warranty
Plan Fee - Buyer:
$
Home Warranty
Plan Fee - Seller:
$
Home Warranty
Plan Fee - Split:
$
Name of Company:
Lender Information
Lender Name:
Lender
Street Address:
Lender
City, State, Zip:
Loan Officer:
Loan Amount:
Selling Loan To:
Endorsements Requested:
EPA
Comprehensive
Variable
Location
Other:
Settlement Date:
Legal Description
Lot Number:
Block Number:
Subdivision:
Section:
Township:
Range:
Personal
Property:
INSPECTIONS: BUYER(S) REQUEST
Name of Company Buyer selected
Inspection
Survey:
Deadline date
Realtor
or
WATC
to order
Termite:
Deadline date
Realtor
or
WATC
to order
Roof:
Deadline date
Realtor
or
WATC to
order
Electric:
Deadline date
Realtor
or
WATC
to order
Furn/CA/
HtWtAt:
Deadline date
Realtor
or
WATC
to order
Whole Home:
Deadline date
Realtor
or
WATC
to order
Underground Sprinkler:
Deadline date
Realtor
or
WATC
to order
Plumbing:
Deadline date
Realtor
or
WATC
to order
Other:
Deadline date
Realtor
or
WATC to
order
Well and Septic inspection
required?
Deadline date
Realtor
or
WATC
to order
If Yes application for
evaluation must be completed by Seller. Mike Gould has forms or our office
can also furnish them to you for seller. When APPLICATION sent to State
BUYER’s $100.00 fee must accompany.
