Commercial Title Application
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Ordering title insurance products is easy! Just fill in the following information and your request for title insurance services will
be transmitted to Old Republic Title’s customer service desk. If you have any questions or need additional information call
612.371.1111 or 800.328.4441. You may FAX orders to us 612.435.9738.
Thank you for placing your order with Old Republic National Title Insurance Company.
*Indicates required fields
General Information
Purchase/Refinance/Other
Owner's Policy Amount
Name of Insured
Lender's Policy Amount
Name of Insured
2nd Mortgage Policy Amount
Name of Insured
Endorsement Options
Comp Yes No
Environmental Yes No
Zoning Yes No
Access Yes No
Survey Yes No
Usury Yes No
Subdivision Yes No
Utilities Yes No
Arbitration Deletion Yes No
Creditor's Rights Yes No
Other Yes No
Additional Services
Construction Disbursing Yes No
Special Assessment Search Yes No
Plat Drawing Yes No
Priority Pictures Yes No
Closing at Old Republic Title Yes No
Closing Date
Property Information
Property Address:
City:
County:
State:
Zip:
Property ID Number
Legal Description:
Property Type
Abstract Torrens
Torrens Certificate Number
Buyer or Borrower
Name:
Name:
Address:
City:  
State:
Zip:
Phone:
Present Owner
Name:
Name:
Address:
City:  
State:
Zip:
Phone:
Any known claims or title issues
Distribution list for order
Customer Information
Name
Address:
City:  
State
Zip Code:
Contact Name
Phone:
FAX:
E-mail*
2nd E-mail confirmation to:
Special Instructions

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