Purchase Order Form Do you want a deed and transfer? Yes No Which county is the property located in? Barron Buffalo Burnett Chippewa Clark Dunn Eau Claire Jackson Pepin Pierce Polk Rusk Sawyer St. Croix Trempealeau Washburn Property Address * Type of Property Residential Commercial Vacant Land Purchase Price * $ Seller Information * First Name Last Name Phone (###) ### #### Email Is this the seller's homestead Yes No Sellers address after closing/current homestead Listing Agent's Information First Name Last Name Email Phone (###) ### #### Listing Commission Breakdown Buyer's Information * Additional Buyer's Information Additional Buyer's Information Additional Buyer's Information How will the buyer take title? A single person Tenants in common (upon death, his/her share passes to his/her estate) Joint tenants (upon death, his/her estate passes to other in title) Will this be the buyer's primary residence? Yes No If no, what is the buyer's current address? Selling Agent's Information First Name Last Name Email Phone (###) ### #### Selling Commission Breakdown Lender's Name (If Financing) First Name Last Name Loan Amount $ Has Vinopal Title done any prior title work? Yes No Closing Date MM DD YYYY Ordered By First Name Last Name Email Phone (###) ### #### Additional Comments Thank you for submitting your order.
