Purchase / Refinance Order Form

If you are a home buyer or a lender, ordering title insurance has just become easier! Just fill in the following information and your title order request will be transmitted electronically or call Customer Service at 800.624.4667 ext 209 or 800.624.4667 ext 210 for assistance.

 

Thank you for choosing Old Republic Title.

General Information and Services Requested:
Services Requested  
Title Insurance    
Search Only    
Foreclosure Search    
Bring Down    
Property Information
Property Location:
Township:
County:
Lot:
Block:

Present Owner
Name:
Address: (if different than property location)
Township:
County:
Lot:
Block:
Marital Status:
Date of Marriage:
Wife's Maiden Name:
Proposed Buyers
Name:
Street Address:
Address (cont.):
City:
State:
Zip Code:
Work Phone Number:
Home Phone Number:
Transaction Information
Purchase Amount:
Mortgage Amount:
Mortgagee:
Street Address:
Address (cont.):
City:
State:
Zip Code:
Phone Number:
Fax Number:
The following services have been requested by your office: (check all that apply)
Closing Service Letter    
Notice of Settlement: Prepare only Prepare and File
Flood Search:    
Survey:
Request Mortgage Payoff:
Mortgage Co. Name:
Account No.:
Phone No.:

Send Copies To
Name:
Street Address:
Address (cont.):
City:
State:
Zip Code:
Phone Number:      
FAX Number:      

Applicant
Name:
Street Address:
Address (cont.):
City:
State:
Zip Code:
Contact:      
Phone Number:      
FAX Number:      
E-mail Address:      
Binder Requested by:      
Proposed Closing Date:      

 

 

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