TITLE ORDER FORM Return to ATG Title Services via Fax: 855.827.3568 or Email: [email protected] Order Date: Delivery Method: (If none specified, we will send via email.) Email: Date Needed: US Mail Pickup UPS Next Day ($10.00 added to Title Preparation Fee) Fax: Ordered By: Member No.: Phone No.: Fax No.: Email: Transaction Type: Type of Property: Purchase (with mortgage) Single Family Cash Deal Condo Refinance Townhome/Coach House Foreclosure Commercial Condo Conversion Master Commitment Mixed Use Tract Search Vacant Land Search Only Apartment Building/2-3 Flat No. of units: BORROWER(S) BUYER’S ATTORNEY Name: Name: SSN (Last 4 digits) or FEIN (in full)*: Address: Name: City, State, Zip: SSN (Last 4 digits) or FEIN (in full)*: Phone: Fax: Address: Email: City, State, Zip: SELLER’S ATTORNEY County: Name: * Non-purchase money mortgage transactions only. Address: SELLER(S) City, State, Zip: Name: Phone: Fax: SSN (Last 4 digits) or FEIN (in full): Email: Name: REAL ESTATE AGENT SSN (Last 4 digits) or FEIN (in full): Name: Address: Phone: Fax: City, State, Zip: Email: Phone: Fax: COOPERATING REAL ESTATE AGENT SELLING PROPERTY Name: Address: Phone: Fax: Email: City, State, Zip: County: PIN: ATG FORM 4221 FOR USE IN: IL © ATG (REV. 2/18) Page 1 of 2 LENDER First Lender Name: Second Lender Name: Contact Name: Contact Name: Address: Address: City, State, Zip: City, State, Zip: Phone: Fax: Phone: Fax: Email: Email: First Mortgagee Clause: Second Mortgagee Clause: Endorsements: Are any titleholders deceased? Yes No ARM Condo Location Name(s): Balloon EPL PUD Purchase Price: $ Other: Loan Amount: $ Second Loan Amount: $ Two Commitments required? Yes No WATER CERTIFICATE/ZONING CERTIFICATE PRIOR POLICY (City of Chicago Only) Yes, attached (Both Schedules A & B) Yes, I would like to order through AT G. No (You will be provided with a Request for Water and/or Zoning Certification (ATG Form 4027), which is also available on our website, www.atg.fom. For more information, contact the ATG Search Department at 312.372.1735.) ADDITIONAL INSTRUCTIONS Ensure encryption or password protection is utilized when transmitting Non-Public Personal Information (NPI) electronically. Alternatives to encryption, such as password protection (e.g., Adobe PDF password protection) of files or transmission by facsimile, are acceptable forms of protecting information. ATG FORM 4221 FOR USE IN: IL © ATG (REV. 2/18) Page 2 of 2 .