Order Title Insurance
First American Title Company of South Dakota

801 MOUNT RUSHMORE RD. STE. 100, RAPID CITY, SOUTH DAKOTA 57701-3541
P.O. Box 8181, Rapid City, SD 57709-8181

TELE: 605-348-4200
FAX: 605-341-6880

e-mail New Orders: orders@firstamsd.com
e-mail Closing Documents: nancy@firstamsd.com

NEW ORDER_*

DATE:

O&E ONLY:
Cancellation Fee is same cost as O&E
order amount, to be billed at time of delivery.

TYPE OF ORDER:
Owner Policy Lender Policy Both

FROM:

Company Name

CONTACT NAME

ADDRESS LINE 1:

PHONE:

ADDRESS LINE 2:

FAX:

COPIES TO:

REALTOR FOR SELLER / COMPANY INFORMATION

REALTOR FOR BUYER / COMPANY INFORMATION

ATTORNEY / COMPANY INFORMATION

CLOSING DATE:

HERE?
Yes No

NEW CONSTRUCTION? Yes No

CONTRACTOR:

BORROWER or PRESENT OWNER: (as a seller)

FATCO DISBURSE?
Yes No

SS#

MARITAL STATUS: SINGLE HUSBAND & WIFE OTHER

NEW OWNER: (as a buyer)

SS#

MARITAL STATUS: SINGLE HUSBAND & WIFE OTHER

LENDER

Company Name

Contact Person

OWNER AMOUNT:
purchase price
$

LOAN AMOUNT:
purchase price
$

EXTENDED COVERAGE?
Yes No

PROPERTY ADDRESS LINE 1:

PROPERTY ADDRESS LINE 2:

City, State, ZIP

LEGAL DESCRIPTION (required):

CURRENT LENDER

LOAN #:

COMMISSION RATE/SPLIT:

DEED PREPARATION?
Yes No

MOBILE HOME?
Yes No

*All orders subject to a cancellation fee.