Date (xx/xx/20xx): This field is required. It is used to secure your information.
Estimated Closing Date:
Ordered By Information
Name:
Company:
Phone:
Fax:
Primary Email: This field is required. It is used for confirmation purposes.
Secondary Email:
Property Information
Sales Price/Owners Policy Amount:
Address 1:
Address 2: (optional)
  City:
County:
State:
Zip:
Lot Size or Condo Square Footage:
Property Identification Number: or Tax Identification Number
Short Legal Description
Property Type (check the box that applies)
Residence/Duplex: 1-4:
Vacant Land/Lot:
Commercial: Type of Commercial Property:
New Construction with Payout:
New Construction without Payout:
Other: Explain:
Prior Title Evidence: - Yes, will be provided - No
Mobile Home on the Property? - Yes - No
Seller/Owner(s)
Name(s):
Current Address:
Address 2:
City:
State:
Zip:
Daytime Phone:
Email:
Forwarding Address:
Address 2:
City:
State:
  Zip:
Phone:
Marital Status:
Married Divorced, not since remarried Single Widow, not since remarried
Buyer(s)
Name(s):
Current Address:
Address 2:
City:
State:
Zip:
Daytime Phone:
Email:
Will this property be owner-occupied? - Yes - No
Marital Status:
Married Divorced, not since remarried Single Widow, not since remarried

Title to be held as:
Joint Tenants Tenants by the Entirety Tenants in Common Severalty

Deliver Copies of Commitment To
New Lender Name:
Loan Officer/Lender Contact:
New Loan Amount/Mortgage Policy Amount:
Phone:
Email:
Fax:
Listing Agent/Company:
Phone:
Email:
Buyer Agent:
Phone:
Email:
Seller Attorney:
Phone:
Email:
Buyer Attorney:
Phone:
Email:
Click "Yes" to have a copy of the commitment sent to the Buyer - Yes - No (Email address of Buyer must be provided above)
Click "Yes" to have a copy of the commitment sent to the Seller - Yes - No (Email address of Seller must be provided above)
Special Instructions:
This site should not be used for the transmission of non-public personal information, such as drivers license or social security numbers.
 
Champaign Office
201 W. Springfield Ave, Suite 101
Champaign, IL 61820

ph: 217.403.3434
fax: 217.403.3435
email: act@actil.net

Peoria Office
8305 N. Allen Road, Suite 4
Peoria, IL 61615

ph: 309.683.1531
fax: 309.692.5977

Springfield Office
3201 Old Jacksonville Road
Springfield, IL 62711

ph: 217.726.3142
fax: 217.547.0220

  
An Agent of Attorneys' Title Guaranty Fund, IncAn Agent of Chicago Title Insurance Company