Please click on the link below to fill out the form. Thank you!

REALTOR APPLICATION FOR TITLE INSURANCE AND ESCROW CLOSING

Seller(s)*

Seller's Address*

Buyer(s)*

Buyer's Address

City, State, Zip*

Sales Price*

Mortgage/Loan Amount

Property Information/Address*

City, State, Zip*

PIN #*

Brief Legal*

Is the Seller Represented by an Attorney?*

YES NO

If yes, who is the Seller's Attorney?

Phone

Email Address

If not, would you like us to order any of the following? (NOTE: Any fees in acquiring these items, will be added to the seller's side at closing time.)

Galena Territory Paid Assessment Letter Deed Prep Mortgage Payoffs (Please have Payoff Authorization Completed, if marked)

LENDER INFORMATION - Lender's Name*

Contact Person*

Email Address*

Phone*

LISTING REALTOR Name*

Email Address*

Phone*

SELLING REALTOR Name*

Email Address*

Phone*

Customer / Title Work Ordered by*

Listing Realtor Selling Realtor

AUTHORIZATION TO RELEASE PAYOFF INFORMATION *

Phone Number*

Loan Number*

Signature*

Social Security Number*

Date*

Signature

Social Security Number

Date

Additional Email

File Upload

PLEASE CHECK*

YES (I (We) hereby authorize my (our) mortgage holder to release loan payoff information to H.B. Wilkinson Title Company. This information is to be used for the sole purpose of gathering information necessary to prepare a closing statement and disburse necessary funds to pay off the existing mortgage at the time of the sale or refinance of my (our) property. A faxed copy of this authorization may be deemed to be equivalent of the original and may be used as a duplicate original.)

Please click on the link below to fill out the form. Thank you!

REALTOR APPLICATION FOR TITLE INSURANCE AND ESCROW CLOSING

321 North Bench Street | Galena, IL 61036
p. 815.777.3318 | f. 815.777.1754

For Closing: closings@hbwtitle.com

For Orders: orders@hbwtitle.com

© Copyright 2026 H.B. Wilkinson Title Co. | site designed by design loft, inc.

Please click on the link below to fill out the form. Thank you!

REALTOR APPLICATION FOR TITLE INSURANCE AND ESCROW CLOSING

321 North Bench Street | Galena, IL 61036p. 815.777.3318 | f. 815.777.1754For Closing: closings@hbwtitle.comFor Orders: orders@hbwtitle.com

© Copyright 2026 H.B. Wilkinson Title Co. | site designed by design loft, inc.

321 North Bench Street | Galena, IL 61036
p. 815.777.3318 | f. 815.777.1754

For Closing: closings@hbwtitle.com

For Orders: orders@hbwtitle.com