Agent's Name *

Agency/ Brokerage *

Phone *

Fax Number

Please leave this field empty.

Email *

Property Address *

Property City *

Property State *
—Please choose an option—OhioKentuckyIndianaTennesseeMichiganMinnesotaWisconsin

Property Zip *

Purchase Price *

Broker Fees *

Selling Commission *

Buyer's Marital Status *
—Please choose an option—SingleMarried

• Ohio dower law requires the spouse’s signatures on mortgages even if they are not in title or on the loan. Dower does not cease until final a final decree of divorce is filed with the court.

Buyer's Name *

Buyer's E-mail *

Buyer's Phone *

Does the buyer want to purchase and Owner's Title Insurance Policy? *
—Please choose an option—YesNoUnsure

Earnest Money Deposit Amount *

Earnest Money to be held by? *
—Please choose an option—Fidelity Land Title AgencySelling Agent/BrokerListing Agent/BrokerSellerBuyerNo Earnest MoneyOther

Is a Home Warranty being purchased? *
—Please choose an option—YesNo

Any additional info your would like us to know about your transaction

*************** WIRE INSTRUCTION DELIVERY INFORMATION ***************

Due to an increase in cyber/wire fraud crime we are letting you know now that
THE MOST SECURE way to obtain our wire instructions is for you or your buyer(s) to log in to our MY CLOSING feature on our website at www.fidelitylandtitle.com . After submitting this form, your buyer(s) will be receiving an invitation to create a login/password to be able to obtain closing docs. and wire instructions directly from our website. Any other transmission of wire instructions that you or your buyer receive should be viewed with extreme caution as they may be fraudulent. Please contact us immediately if you are your client receive wire insturctions by an other manner than through our website's My Closing feature. Our wire instruction will not change. We ask that you please relay this information on to your buyers.

I have read the above disclosure about wire instruction delivery:Check here if you accept these terms.

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