Reliable Land Title Corporation

PLACE ORDER FOR TITLE INSURANCE AND CLOSING ONLINE
You may place an order over the Internet using this page. When you click “Submit” an email will be generated from the information you’ve entered and immediately transmitted to our offices where we will start the process. Please fill in as much information as you can but don’t be intimidated by all the questions. The more information we have the better we can serve you but with just a few facts, marked with a “*” as required, we can begin and contact you for more during the process. You may also click here to open a page “PDF” format that you can complete, print and fax to us if you prefer. Our fax numbers are printed at the top of that form. Thank you for your business and please do not hesitate to call us personally if we can assist you in any way

contact Information

*First Name:
*Last Name:
*Daytime Phone:
*Email:
Street Address:
City:	State: Zip:
* Required Information

current property owner information

*First Name of Property Owner:
*Last Name of Property Owner:
*Daytime Phone:
*Email:
Fax:
Mailing Address:
City:	State: Zip:
* Required Information

current property information

*Street Address:
City:	State: Zip:
*Legal Description:	Please fax us a COMPLETE LEGIBLE copy of the Purchase and Sale Agreement and/or Loan Commitment as soon as possible. Navarre Fax 850-0936-5606, Pensacola Fax 850-469-9520
* Required Information

buyer and/or borrower Information

Is the Refinance Transaction and Owner/Borrower one in the same? Yes No If no, please complete the following.
*First Name:
*Last Name:
Daytime Phone:
Email:
Fax:
Street Address:
City:	State: Zip:
* Required Information

lender Information

Loan Officer or Contact Name:
Phone Number:
Email:
Fax:

realtor Information - listing agent

First Name:
Last Name:
Agency:
Office Phone:
Cell Phone:
Email:

realtor Information - selling agent

First Name:
Last Name:
Agency:
Office Phone:
Cell Phone:
Email:

survey information

We will use:

A new survey which will be:

Ordered By:
Ordered From:

(The Buyer/Borrower acknowledges a new survey is being obtained for this transaction and exception(s) will be taken on the policy(ies) issued for matters revealed by that survey.)

An existing survey, if acceptable, a copy of which is being emailed or faxed to Reliable.

(The Owner/Seller acknowledges they must sign a sworn affidavit as to improvements made regarding the property since such survey was produced which may affect the acceptability of the survey for Title Insurance purposes. The Buyer/Borrower acknowledges a new survey is not being obtained for this transaction and exception(s) will be taken on the policy(ies) issued for matters revealed by the existing survey and affidavit. The Buyer, Seller and/or Borrower assumes all liability regarding any infringement or violation of any copyrights held or claimed by the producer of such prior survey and agree to hold Reliable Land Title Corporation, it’s employees, and agents harmless from any loss or damage arising from such use including court costs and attorney’s fees.)

In place of a survey, the seller will furnish a prior Owner's Policy of Title Insurance in which the general survey exception has been deleted, a copy of which is being emailed or faxed to Reliable.

(The Owner/Seller acknowledges they must sign a sworn affidavit as to improvements made regarding the property since that policy was issued which may affect the acceptability of the survey for Title Insurance purposes. The Buyer/Borrower acknowledges a new survey is not being obtained for this transaction and exception(s) will be taken on the policy(ies) issued for matters revealed by such prior policy and affidavit. All parties also acknowledge that the new policies of title insurance must be underwritten on Old Republic National Title Company in this circumstance.)

The parties do not desire a survey and acknowledge that any policy(ies) of Title Insurance issued will contain an exception from coverage for matters which should be revealed by an accurate survey and inspection of the premises.

wood destroying organisms or termite report

A WDO is not desired by the parties nor their Lender.

A WDO report has been or will be ordered

From:
By:

current mortgage information

The property is currently subject to mortgages held by the following:
First Mortgage
Second Mortgage
Third Mortgage

property insurance

The Buyer and Lender do not desire Property Insurance.

The Buyer/Borrower has made or will make application for insurance with the following:

Hazard Insurance Agent Name:
Contact Name:
Phone Number:
Email:
Fax:
Flood Insurance Agent Name:
Contact Name:
Phone Number:
Email:
Fax:
Windstorm Insurance Agent Name:
Contact Name:
Phone Number:
Email:
Fax:

homeowners, condominium, or property owners association

Don't know if one exists affecting this property
There is not one affecting this property
There is one and known contact information follows

Contact Name:
Phone Number:

Navarre Phone: 850-936-5600 • Navarre Fax: 850-936-5606 • Pensacola Phone: 850-469-9402 • Pensacola Fax: 850-469-9520 • info@reliableland.com
Copyright Reliable Land Title Corporation 2006. All Rights Reserved.
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