TITLE INSURANCE ORDER FORM.
Slaby Deda Law Offices are issuing agents for Old Republic.
REQUEST FOR TITLE POLICY
Requested by:
I/we would like to request the following, (check all that apply):
Owner’s Policy
Loan Policy
Letter Report
PROPERTY INFORMATION
1a. Is the property located in Price County?
Yes, inside Price County
No, outside Price County
1b. If not in Price County, what county is it located in?
2. What is the property's classification?
Homestead
Second Home
Rental
Agricultural
Commercial
Vacant Land
Other
3. Tax ID number(s) of sale property:
4. Address or description of sale property:
5. Sale price:
6. Prior policy number, if applicable:
SELLER'S INFORMATION
7. Seller's name:
8. Seller's address:
9. Seller's phone:
10. Seller's email:
BUYER'S INFORMATION
11. Buyer's name, reflecting how the buyer(s) will be titled:
12. Buyer's address:
13. Buyer's phone:
14. Buyer's email:
15. Relationship between parties, if any:
FINANCING INFORMATION
16a. Financing:
Yes, financing
No, no financing
16b. If "yes," what is the loan amount?
17. Lender's name:
18. Lender's address:
19. Does the lender require a Closing Protection Letter (CPL)?
Yes, CPL required
No, CPL not required
20a. Is GAP coverage needed?
Yes, GAP coverage is needed
No, GAP coverage is not needed
20b. If "yes" to GAP coverage, at the buyer's or seller's expense?
Buyer's Expense
Seller's Expense
21. List other endorsements requested:
ADDITIONAL INFORMATION
22. Closing date:
23. Bill owner's policy to:
24. Bill loan policy to:
25a. Do you need further assistance with deed preparation or an insured closing?
Yes, I need further assistance
No, I do not need further assistance
25b. If "yes," please indicate:
26. Is there anything pertinent regarding this transaction or the property which we should know about?
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