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Western Title
Phone: (308) 532-4500
Fax: (308) 532-4247

 

Place an Order

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
Buyer Type:
Present Address:
City, State, Zip:
Phone (Home):
Phone (Work):
Phone (Cell):
Email Address:
H SS#:
W SS#:
Purchasers Attorney:
Seller:
 
Seller's Marital Status: H&W Single
Buyer Type:
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):
Email Address:
H SS#:
W SS#:
Present Lender:
Loan No:
Sellers Attorney:
Contract Sales Price: $   Earnest Money: $  

Property Address:

City:

State: Zip:
County:
Choose Type of Property:
Listing Agent/Broker:   
Selling Agent/Broker:    
Total Commission Rate:
Advertising Fee: $
Doc Retention Retrieval Fee Fee: $
Home Warranty Plan Fee: $
Home Warranty Plan Payment By:
Name of Company:


Lender Information

Lender Name:





Lender Street Address: 
Lender City, State, Zip: 
Loan Officer: 
Loan Amount:
Selling Loan To:

Endorsements Requested:

EPA

Restriction

Variable


Location

Manufactured Housing: 

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.
Special Instructions:

 

 

 

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