TITLE INSURANCE ORDER FORM. Slaby Deda Law Offices are issuing agents for Old Republic.

Slaby Deda Law Offices are issuing agents for Old Republic.


Requested by:

I/we would like to request the following, (check all that apply):


1a. Is the property located in Price County?

1b. If not in Price County, what county is it located in?

2. What is the property's classification?

3. Tax ID number(s) of sale property:

4. Address or description of sale property:

5. Sale price:

6. Prior policy number, if applicable:


7. Seller's name:

8. Seller's address:

9. Seller's phone:

10. Seller's email:


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:


16a. 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)?

20a. Is GAP coverage needed?

20b. If "yes" to GAP coverage, at the buyer's or seller's expense?

21. List other endorsements requested:


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?

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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