Welcome to Luxury Title Agency

Password

Key Personel

Helpful Links

Offices

Mineola Office
170 Old Country Rd Ste 508 Mineola, NY 11501
516-364-HOME (4663)

Dix Hills Office
875 East Jericho Turnpike
Dix Hills, NY 11746
631-424-HOME(4663)

Order A Title

Client Information

My name:	*
Company name: (if applicable)	*
My street address: (Line 1)	*
My street address: (Line 2)
My city:	*
My state:
My zip:	*
My Phone Number:	*
My Fax:	*
My email address:	*

Title Search Information

Title Search:	Purchase Search Refinance Search Other, Specify:
Mortgage Amount:	$
Sale Price:	$
Coop Name (if applicable):
Loan/Reference Number:
Mortgage Lender (if available):
Survey Instructions:
Municipality/Dept. Instructions:	Standard Search by County Tax and Bankruptcy Only

Address of Property

Number/Street:	*
City/State/Zip:	*
Section:
Block:
Lot:

Participant Information

* Owner #1:	SSN:
Owner #2:	SSN:
Purchaser #1:	SSN:
Purchaser #2:	SSN:

Lender Information (if different than applicant)

Lender:
Attention:
Street Address:
City:
State:
Zip Code:
Phone:
Fax:
Email Address:

Lender's Attorney

Firm:
Attention:
Street Address:
City:
State:
Zip Code:
Phone:
Fax:
Email Address:

Purchaser's Attorney (if different than applicant)

Firm:
Attention:
Street Address:
City:
State:
Zip Code:
Phone:
Fax:
Email Address:

Seller's Attorney

Firm:
Attention:
Street Address:
City:
State:
Zip Code:
Phone:
Fax:
Email Address:

Additional comments or notes: