Hickman Land Title Company
Title Insurance Order Form

Please fill in as much information as you can before placing your order. If you have
any questions please call one of our offices. If you would prefer you may print an order
form that can be filled out and faxed to our office by clicking here.
If you have documents such as a REPC please fax them to our office.

Logan, UT ~ ph 435-752-0582 fax 435-752-0584
Garden City, UT ~ ph 435-946-2652 fax 888-242-8205
Layton, UT ~ ph 801-416-8900 fax 801-416-8950
Salt Lake, UT ~ ph 801-293-7700 fax 801-303-6838
Jackson, WY ~ ph 307-733-4713 fax 307-733-6186
Thayne, WY ~ ph 307-654-4713 fax 307-733-6186

*Required items

  Contact Infomation
Name:*
Email Address:*
Company:
Phone Number:*
Fax Number:
Address:

City/State/Zip Code:
I am the:
Please send to
alternate address:
Please send
additional copies to:

  Property Information
Property County:*
Property Address
and/or Description: *
Property Tax ID Number:
Current Owner:

Owners Social Security #:

Owners Social Security #:

Owners phone #'s:

Buyer/Borrower:
(If different than above)

Buyer/Borrower
Social Security #:

Buyer/Borrower
Social Security #:

Buyer/Borrower
phone #'s:
(Social Security numbers will help to eliminate showing judgments under similar names.)

  Transaction Information

Type of Transaction: (Check all that apply)
Sale Refinance
Second Mortgage PR Only
Home Equity O&E Report (Wyoming only)
Limited Report Foreclosure Report
New Construction Has Construction Started?
Long Term       Yes   No
Other:

Type of Policy: (Check all that apply)
Owners Policy                               Sale's Price: $
Lenders Policy                           Loan Amount: $
Second Lenders Policy             Loan Amount: $
Residential Limited Policy         Loan Amount: $
Endorsements:
Standard 3 (100, 116, 8.1)   ARM   Balloon     Others:

Closing Information: (Provide as much information as possible)
Closing Type: Full Closing Mini Closing No Closing
Proposed Date:
Payoff Information:
Lender: Loan Number:
Lender: Loan Number:
Which office do you want to close at?
Do you have a prefered Escrow Officer?
Have you been working with one of our
Marketing Representives?
 
Additional Comments and/or Instructions:
 

Logan, UT 435-752-0582
Salt Lake, UT 801-293-7700
Jackson, WY 307-733-4713
Utah Toll Free 800-365-7720
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 Layton, UT 801-416-8900
Garden City, UT 435-946-2652
Thayne, WY 307-654-4713
Wyoming Toll Free 800-289-9920

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