Title Insurance Order

This application is for the Seller to complete in a FSBO situation.

May we suggest that an “Authorization to Release Confidential Information” be submitted via fax or mail with this application. This form enables us to order payoffs and retrieve information for the Seller’s Closing Statement.

To ensure a prompt response, please make sure you fill out as many of the listed fields as possible. Your information will be kept confidential. We won’t sell, trade, or lease your information to anyone.

*Name:
*Email:
*Property Address:
*Sale Price:
*Sellers:
*Current Address:
Homestead:  Yes  No
*Buyers:
Current Address:
Homestead:  Yes  No
Buyer's Lender:
Lender's Address:
Phone:
Fax:
Loan Amount:
Loan Type:
Requested Endorsements:
Proposed Insured:  Same     To read as follows:
*Anticipated Closing Date:
Legal Description:
Property Type:  1 - 4 Family Residential
 Condo
 Land
 Commercial Property
 Other:
Prior Title Evidence:

 Pickup Abstract at:  or
I'll fax a copy of the old title insurance

Conditions of Title Known:
(Shared driveway, shared well, easements.)
Attorney for Seller:
Attorney for Buyer:
*Special Instructions:
*Required  

Thank you for choosing Assurance Title, where our pledge to you is safety, certainty and confidence.