ONLINE ORDER for Title Insurance

ORDER FOR TITLE INSURANCE 

* Denotes Required Field                                                                   

If you desire to clear this form and start again, use this button:

	Please answer all questions
	Do not press Enter at anytime before you are completed filling out the form.  If you submit the form before the information is complete, please use your  back button, finish the form, and re-submit.
	Names, amounts, legal descriptions, etc., must be shown EXACTLY as they  are to appear on the commitment.

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
PROPOSED INSURED:            

ASSIGNEE OF MORTGAGE, IF ANY:

SURVEY 

SURVEY ORDERED BY: ON (DATE):

SURVEY NOT REQUIRED  (PLEASE SKIP TO CLOSING)

(We will need a copy of the survey and purchase agreement sent to this office with a note attached that your order was placed on the web).

CLOSING

WILL THE CLARK TITLE COMPANY BE DOING THE CLOSING?     YES     NO

APPROXIMATE CLOSING DATE NEED BY

TYPE OF CLOSING:
REFINANCE        PURCHASE        ASSUMPTION

WILL THE BUYER BE LIVING ON THE PREMISES?     YES      NO

PROPERTY

ADDRESS OF INSURED PROPERTY:               BUYER/BORROWER MAILING ADDRESS:
 

LEGAL DESCRIPTION:                                     SELLERS NAME & 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 UNRECORDED CONTRACTS?    YES    NO
IF YES, 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 TO HANDLE LOAN DISBURSEMENT?    YES    NO

ANY IMPROVEMENTS OR REPAIRS?     YES    NO (within the last 6 months)

FINANCING

6 (ARM)   8.1 (EPA)  ENDO-100  
SPECIAL ENDORSEMENTS      OTHER

Mail	Deliver	Fax	Bill		Copy	Original
				Lender Name      Address
				Listing Agent Name      Address
				Selling Agent Name      Address
				Attorney Name      Address
				Attorney Name      Address
				Other     Name      Address

COMMENTS

ORDER INFORMATION

* Ordered By: Company Name:
  Contact Person:
* Phone: Fax: * E-Mail:
* Billing Address: * City:
* State: * Zip:

    (If you need to clear the form and begin again, please return to the top for instructions)