Polk County Title Services, Inc

If you would like to fax us your own application form, please fax to 715-246-0115.

* Required Information

SERVICES REQUESTED

Title Insurance

Due By

Closing Services

Closing On

REQUESTED BY

Attn

Company

Address

Fax

PROPERTY INFORMATION

Owner

Buyer/Borrower

Property Address

Parcel Number

Legal Description

Type Of Transaction

Sale or New Mortgage
2nd Mortgage
Refinance

Land is

Vacant \\ Residential \\ Commercial

Type of Property

New Construction
Commercial Property
Existing Housing

Buyer Financing

Cash \\ Bank Financing \\ Land Contract

TITLE INSURANCE POLICY

Is there a previous policy?

Yes (please provide copy to title order) \\ No

Is there an abstract?

Yes \\ No

Comments:

PROPOSED INSURED

Owner

1st Mortgage

2nd Mortgage

Endorsements Required

Special Instructions

"We Do Good Deeds"
Polk County Title Services, Inc.
PO Box 197, Amery, WI 54001 (715) 268-4524