Title Request Form

Virginia Home Title & Settlements
Title Request Form

YOUR NAME: CONTACT #:
(Phone Number: 555-555-5555)
EMAIL: OTHER:
STREET ADDRESS:
CITY: STATE: ZIP:
AND LEGAL DESC.:
REASON FOR TITLE SEARCH:
BUYER INFO: NAME(S)
CONTACT INFO:
(Contact Number: 555-555-5555) 		MISC.:
LENDER INFO: PHONE:
(Phone Number: 555-555-5555)
SELLER INFO: NAME(S)
CONTACT INFO:
(Contact Number: 555-555-5555) 		MISC.:
  1. PAYOFF INFO: LENDER(S)  PHONE:
    (Phone Number: 555-555-5555)
    Also use this Payoff section for Refinance
    LOAN NUMBER(S):
  2. PAYOFF INFO: LENDER(S)  PHONE:
    (Phone Number: 555-555-5555)
    Also use this Payoff section for Refinance
    LOAN NUMBER(S):
Please see authorization letter attached for Lender Pay Offs.
TITLE SEARCH NEEDED BY:
CLOSING DATE:
(Date Format : mm/dd/yyyy)
COMMENTS/MISC.:
PREFERRED CLOSING OFFICE/OFFICER:
 
YOU WILL RECEIVE CONFIRMATION OF RECEIPT WITHIN 24 HOURS DURING BUSINESS HOURS MONDAY THROUGH FRIDAY (EXCEPT HOLIDAYS).