Land Package Order Form

Parcel Information
Please enter as much information about the subject parcel as you can. The information in this section is in regards to the parcel itself, not the person requesting the information (that will be entered later).
Property Address*
Street Address City State ZIP Code
Location
Please provide the Township, Range, Section and Tax Lot number for the subject parcel. If the property contains more than one parcel, click the + symbol to add new rows.
Township N/S Range E/W Section Tax Lot
Property Owner*
Enter the name(s) of the person(s) or business(es) that own the subject property.
Reason for this request*
- Sale
- Rental
- Lease
- Purchase
- Loan
- Development
- Permit Requirement
Other Information
If there is any other information you can provide about the location or type of this property that might help us in our research, please provide that information here.

Requestor Information
Please provide the following information about you, the requestor of our Land Package, so that we may follow up with you and provide the results to you.
Your Name*
Your Phone Number*
Your Email Address*
Enter Email Confirm Email
Your Company Name
What's the best way to reach you?*
Billing Address*
Street Address Address Line 2 City State ZIP Code

Checkout
Please complete the payment details and submit so we can start processing your order.
Total of your order
This is the amount that will be charged to your credit card.
$0.00
Payment Method*
- I would like to pay with PayPal
- I would like to pay with my credit card
The email address you entered previously will be used to process your PayPal payment.
Pay via credit card

American Express
Discover
MasterCard
Visa
JCB
Card Number Expiration Date Security Code Cardholder Name
Coupon Code
Do you have a coupon code? If so, enter it here.
Discount For Package #1
10% discount for first-time purchasers.
Discount For Package #2
10% discount for first-time purchasers.
Discount For Package #3
10% discount for first-time purchasers.
Name
This field is for validation purposes and should be left unchanged.

Township	N/S	Range	E/W	Section	Tax Lot

Parcel Information