718.808.0234
excland(at)gmail(dotted)com

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Exclusive Land Services, Inc.

107 Fingerboard Rd, Staten Island NY 10305

Ph: 718.808.0234 | Fax: 718.732.2323
Email: Excland(at)gmail(dotted)com
www.ExclusiveLandServices.com

    Please check all that apply:
    Applicant: Ordering agent/attorney: Company Name: Address:
    Phone:
    Fax:
    E-mail:
    Property Address: Current Owner(s): Buyer(s):
    Purchase Price: $
    Loan Amount: $
    Lender: Buyer’s Attorney: Sellers Attorney: Lenders Attorney:

    ****You may fax or e-mail this form, or visit our website above and submit your order electronically****

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