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Date of Request
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The undersigned party hereby requests the following Engineering/Surveying services.
Topographic Survey
As Built Survey (with current dated plan and Surveyors Report)
ATLA Land Title Survey (attach Table A)
Boundary Survey (with PWD Drawing and Description of Work)
FEMA Elevation Certificate (for Flood Insurance)
Subsurface Utility Engineering
Other
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Property Address
PWD Drawing Number
Quarter Name
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Structure on Premises
Yes
No
If yes, occupied by owner
Yes
No
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Transaction Type
Purchase
Refinance
Other
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Borrower/Buyer
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Tele Numbers
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Owner
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Tele Numbers
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Certify To
Trinity Title and Trust Company
Lawyers Title and Insurance Company
Chicago Title Insurance Company
Fidelity National Title Insurance
V.I. Title and Trust
Island Title Services Corp.
Stewart Title Guaranty Company
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Anticipated closing date or date when services are needed
(Turnaround time varies depending on current workload. **Rush jobs will include an expedition fee**)
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Name of Ordering Party
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Tele. Number
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Bill To
Signature of Person Responsible for Payment
A Deposit is required to schedule professional services:
Bounday Survey: $350-500
As Built: $250
Topographic Survey: $400
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Indicates Response Required
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