Liberty Title, Inc.


	6545 West Central Avenue \| Suite 101 \| Phone: (419) 517-5000 \| Fax: (419) 517-5001	www.libertytitleusa.com

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Fill out the order form below to order your title online or print out our order form and fax it to us by pressing the link at the bottom of the page. Please note that when ordering title a valid email address must be provided.

Contact Information

Date:
Your Name:
Your Company:
E-mail Address:
Phone Number:
Fax Number:

Customer Information

Borrower Name:

Co-borrower Name:
Phone:
Address:
Fax:
City:
Type of Title:
Sales Price:
Property Addr:
Property City:

Seller Name :
Seller Name2:
Buyer Name:

Lender Info

Lender Name:
Lender Address:
Lender City:
Lender State:
Loan Amount:
Loan Type:

Listing Broker:
Selling Broker:
Buyers Attorney:
Sellers Attorney:
Title Needed by:

Pay Off Information

Pay-Off 1: Account#:
Pay-Off 2: Account#:
Pay-Off 3: Account#:
Pay-Off 4: Account#:
Pay-Off 5: Amount#:

We will deliver the finished title to all parties checked below

Party

Original

Copy

Seller:

Buyer:

Lender:

Customer:

Or you can download the order form by pressing below and fax it to us.

Download Order Form

Please print out the order form and then fax it to our office at:

419-517-5001