Countywide Abstract
104 South Church Street
West Chester, PA 19382
Phone: 610-431-3600    Fax: 610-431-1363

TITLE APPLICATION

PLEASE PROVIDE THE FIRST PAGE OF THE AGREEMENT OF SALE

PRINT & FAX TO 610-431-1363

AGENT'S NAME ________________________________________              DATE _______________
ADDRESS ________________________________________         PHONE # ____________________
                   ________________________________________              FAX # ____________________
                   ________________________________________

SUBJECT PREMISES ____________________________________________________________
TOWNSHIP/BOROUGH _________________________               COUNTY ____________________
TAX PARCEL # _________________________            DEED REFERENCE ____________________
PRESENT OWNERS ____________________________________________________________
ADDRESS ________________________________________         PHONE # ____________________
                   ________________________________________              FAX # ____________________
                   ________________________________________
OWNER SS # ____________________                           2ND OWNER SS # ____________________

BUYERS ____________________________________________________________
ADDRESS ________________________________________         PHONE # ____________________
                   ________________________________________              FAX # ____________________
                   ________________________________________
BUYER SS # ____________________                              2ND BUYER SS # ____________________

SALE PRICE ____________________                              LOAN AMOUNT ____________________
MORTGAGE COMPANY _______________________________________________________
ADDRESS ________________________________________         PHONE # ____________________
                   ________________________________________              FAX # ____________________
                   ________________________________________
CO-OP BROKER ____________________                 AGENT NAME _________________________
AGENT PHONE # ____________________                                        FAX # ____________________

PROPOSED SETTLEMENT DATE: __________         
NOTES:

ORDER PAYOFFS:   YES   OR   NO
PRESENT LIEN HOLDER _______________________________________________________
ACCOUNT # ____________________                                          PHONE # ____________________
ORDER TAX CERTS:   YES   OR   NO
ORDER WATER/SEWER:   YES   OR   NO
WELL:   YES   OR   NO
SEPTIC:   YES   OR   NO

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