ONLINE ORDER for Title Insurance

ORDER FOR TITLE INSURANCE 

* Denotes Required Field                                                                   

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	Names, amounts, legal descriptions, etc., must be shown EXACTLY as they  are to appear on the commitment.

OWNER'S  POLICY AMOUNT: $  EXTENDED COVERAGE YESNO
PROPOSED INSURED:            
Joint Tenants    Tenant in Common    Other

Single    Married - SPOUSE'S NAME:

LENDER'S  POLICY AMOUNT: $  EXTENDED COVERAGE YESNO
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).

CLOSING

WILL THE CLARK TITLE COMPANY BE DOING THE CLOSING?     YESNO

APPROXIMATE CLOSING DATE NEED BY

TYPE OF CLOSING:
REFINANCE   PURCHASE   ASSUMPTION

PROPERTY

ADDRESS OF INSURED PROPERTY:               BUYER/BORROWER MAILING ADDRESS:
 

LEGAL DESCRIPTION:                                     SELLERS NAME & MAILING ADDRESS:
 

RESIDENTIAL	YESNO
• MOBILE HOME	YESNO
• DUPLEX	YESNO
• CONDO	YESNO
• APARTMENT HOUSE	YESNO
MAIN RESIDENCE	YESNO
COMMERCIAL	YESNO
BARE LOT	YESNO
FARMLAND	YESNO

TITLE IS NOW VESTED IN:

ARE THERE ANY UNRECORDED CONTRACTS?    YESNO
IF YES, A COPY WILL NEED TO BE PROVIDED

WILL THIS BE A NEW CONSTRUCTION? YESNO
IF YES, NAME OF GENERAL CONTRACTOR

ANY IMPROVEMENTS OR REPAIRS?     YESNO (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:

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