Order your Title Insurance

ERROR: Please fix the following issues then resubmitt this form...

    Before you fill out this form please read the instructions below.

  • Please answer all questions.
  • Names, amounts, legal descriptions, etc., must be shown EXACTLY as they are to appear on the commitment.
  • (*) Indicates required fields

Owner and Lender's Information

Owner's Policy Amount: $  Extended Coverage? Yes  No
Proposed Insured:
Joint Tenants   Tenant in Common   Other
Single    Married    → Spouse's Name:
Lender's Policy Amount: $   Extended Coverage? Yes  No
Assignee of Mortgage, If Any:

Survey Information

Survey Ordered By: On(Date):
Survey Not Required
(We will need a copy of the survey and purchase agreement sent to this office with a note attached that states that your order was placed on our website)
I want to upload a copy of my survey and/or purchase agreement

Upload Survey and Purchase Agreement

Note: Please ensure that the document you're uploading is either a PDF or in a Microsoft Word format (docx)!
Survey (pdf/docx)
Purchase Agreement (pdf/docx)

Closing Information

Will The Clark Title Company be doing the closing? Yes   No
Approximate Closing Date:    Needed By:
Type of Closing:
Refinance   Purchase   Assumption
Will The Buyer be Living on the Premises? Yes   No

Property Information

Address of Insured Property:
 Buyer's/ Borrower's Mailing Address:
Legal Description:
 Seller's Name and Mailing Address:
Residential Yes   No
Mobile Home Yes   No
Duplex Yes   No
Condo Yes   No
Apartment House Yes   No
 
Main Residence Yes   No
Commercial Yes   No
Bare Lot Yes   No
Farmland Yes   No
Title is now Vested in:
Are there any unrecorder contracts? Yes   No
If so, a copy will need to be provided.
 
Does this transaction involve construction? Yes   No
If yes, name of general contractor:
 
Has Construction been started? Yes   No
 
Is Clark Title handling loan disbursement? Yes   No
 
Any Improvements or Repairs?(within the last 6 months) Yes   No

Endorsements

6(ARM)    8.1(EPA)    ENDO-100
Special Endorsements    Other:

Comments

Comments:

Choose where to send Title Insurance:

Bill Address Info Copy Original
Lender

Name:


Address:
Listing Agent

Name:


Address:
Selling Agent

Name:


Address:
Attorney 1

Name:


Address:
Attorney 2

Name:


Address:
Other



Name:


Address:

Order Information

*Ordered by:    Company Name:
Contact Person:
*Phone:    Fax:    *Email:
*Billing Address:
*City:    *State:    *Zipcode: