Copper Range Abstract & Title Agency, Inc.

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707 Shelden Avenue
Houghton, Michigan 49931

(906) 482-7903 [t]
(906) 482-7977 [f]

Hours:
Monday - Friday
8:30 AM to 4:30 PM

Order Insurance

*Fields marked with an asterisk () are required. Thank you.**

Date Ordered:

Date Needed:

Your File/Loan Number:


POLICY TYPE:

Owner's Policy:	Mortgage Policy:

$	$

Transaction:


Would you like us to conduct the closing?
Yes - >>>>>>>>>>>>>>>>>>>>>>>>>	Would you like us to order the deed? Yes No
No	Reminder: Please provide addresses of parties and indicate how title will be held.
	If you would like us to obtain mortgage payoff(s), please print and send our required payoff authorization form:
	Word File PDF File

BUYER(S) OR MORTGAGOR(S):

Name(s):

Street Number & Name:

City & State:	Zip Code:

Husband and Wife
Joint w/Full Right of Survivorship (JT W/FROS)
Tenants in Common

LENDING INSTITUTION:

Broker:

Lender: (as name should appear on title commitment)


SELLERS:

Name(s):

Street Number & Name:

City & State:	Zip Code:


LEGAL DESCRIPTION OF REAL ESTATE:

Tax Identification Number of Real Estate:

County:

Township/Village:

Described As:


STREET ADDRESS OF REAL ESTATE:

Street Number & Name:

City & State:	Zip Code:


CHARGE AND DELIVER TO:

Company Name:*

Attention:

Street Number & Name:

City & State:	Zip Code:

Phone:	Fax:

E-mail:


Additional Copies To:


Additional Instructions:


Verification

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