ORDER SERVICES — TITLE EXCHANGE COMPANY

ORDER SERVICES

EXCHANGER

Name

First Name

Last Name

Spouse

Address

City, State & Zip Code

Phone

(###)

###

####

Email Address

RELINQUISHED PROPERTY

Brief Legal

Address

City, State & Zip Code

Title Held By

Buyer's Name

Sales Price

Tax Basis

Closing Information

Title Company/Closing Agent

Phone

(###)

###

####

Fax

(###)

###

####

Email

Exchangor's Attorney or CPA Information

Firm

Name

Phone

(###)

###

####

Address

City, State & Zip Code

Replacement Property Information