Authorized Title & Escrow, Inc : Title Order Form


Electronic Title Insurance Order Form
Please fill out the following to electronically order any of our Title Insurance Services. Once your order is placed, it will be immediately processed and you will receive confirmation of your title insurance order via phone or email.
Please Note: All third-party search fees incurred by this company on your behalf, for the purpose of issuing a Title Commitment Binder, will be billed to you upon receipt of your order and placement of the search.
Cancellation of processed orders prior to closing may result in document handling and prep charges in addition to third-party search fees.
By submitting your order through our online service, you agree to the above terms and conditions.
* required information:

YOUR CONTACT INFORMATION

* Name:
* Title:
* Company:
* Billing Address:
* City:
* State:
* Zip:
* Contact Phone:		Ext:
Fax:
Mobile Phone:
Email:
Website:

ABOUT THE TRANSACTION & PROPERTY

* Need By Date:
* Title Service Order Request: (select one)		Commitment for Title/Title Policy Title Report Search Only
Search Only Requests: (Please list the type of search you would like on this property)		Sample: County Only or Current Owner Search; or Current Owner plus Judgements, etc.
* Transaction Type:
* Loan Type:
Sales Price:
Loan Amount:
* Address of Property:
* City of Property:
* State of Property:
* Zip Code of Property:
* County of Property:
* Lot Number:
* Block Number:

CURRENT OWNER INFORMATION

About Current Owner: (select one)		Current Owner is a Company Current Owner is a Private Individual Current Owner is Unknown
* If Owner Is a Company:
* If Owner Is an Individual: (provide full name and middle initial)
* Address of Current Owner:
* City of Current Owner:
* State of Current Owner:
* Zip Code of Current Owner:
Phone Number of Current Owner:
Additional Owner(s): (please check as appropriate)		Yes, Additional Owner is a Spouse Yes, Additional Owner is a Business Partner Yes, Additional Owner is a Relative Yes, Additional Owner is "other" No, All Owners are listed above No, All Owners are unknown
If Additional Owners: (provide full names and middle initials)

BUYER INFORMATION

About Buyer: (** required if transaction is a purchase)		Buyer is a Company Buyer is a Private Individual(s)
** If Buyer Is a Company:
** If Buyer(s) is (are) an Individual(s): (provide full names and middle initials)
** Buyer(s) Current Mailing Address(es): (include street address, city, state & zip for each address)
** Buyer(s) Home Phone: (provide area codes)

MISCELANEOUS INFORMATION

Please provide any extra information or requests that might be helpful:		Would you like us to contact all parties involved in this transaction? Is back title available? This would be the area to provide any extra pertinant information.