Application for Title Insurance:
Real Estate Sale

This application is for the Listing Agent (Realtor) or Lending Institution in a FSBO situation to complete. If you are a “For Sale By Owner” Seller, click here.

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:
*Listing Agent & Firm:
*Commission %:
Administration Fee:
*Selling Agent & Firm:
*Special Instructions:  Order City Letter
Order Deed & Transfer through:

(Name of Attorney)
*Ordered By/Name & Co:
*Required Fields  

Please drop off or fax a copy of the Offer to Purchase, any Addendums and Amendments to (920) 235-2122. We need a fully executed Offer to Purchase and supporting documentation to prepare the Seller’s Closing Statement.

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