Assurance Land Title Order Form
Order Information
Date:
Estimated Close Date:
Lender
Telephone:
Fax:
eMail:
Ordered by
Telephone:
Fax:
eMail:
Loan Processor
Loan Officer
Selling Agent
Seller/Owner
Property
Address:
Seller and Buyer Information
Seller:
Home Phone:
Work Phone:
eMail:
Married
Not Married
Buyer:
Home Phone:
Work Phone:
eMail:
Married
Not Married
Transaction Information
Type:
Purchase
Refinance
Construction
Tax & Legal
Reissue Rate
Sale Amount:
Loan Amount:
Insured Lender to Read:
For purchases, please fax the agreement to (330) 965-1555 or eMail it to
tony@assurancelandtitle.com
Policy Information
Policy:
ALTA Policy
Loan Only
Title Guarantee
Other
Endorsements Required
Survey (OH21)
EPA (8.1)
Condo (4)
Conditions and Restrictions (100)
Comprehensive (9)
ARM (6.0)
Address (116)
Other
Assurance Land Title to:
Schedule & Close Loan
Prepare Deed
Order Location Survey
Order Termite Inspection
Other
Special Instructions