(516) 792-3175; Fax (516) 792-3178
Name:
Address:
Phone: Fax:
APPLICATION FOR TITLE INSURANCE
Date Ordered: __________________ Title No.: _______________
Type of Transaction (circle all that apply):
REFINANCE PURCHASE RESIDENTIAL COMMERCIAL
Fee/Owner’s Policy: $_____________________ Mortgage Policy: $ _________________
Record Owner(s):_____________________________________________________________________
Purchaser/Mortgagor(s):________________________________________________________________
Lender: _____________________________________________________________________________
Premises Address: Tax ID#:
Dist: Sec:
Block:
Purchaser’s Attorney: Order the following searches:
[ ] Certificate of Occupancy
[ ] Tax
[ ] Street Report
Seller’s Attorney: [ ] Bankruptcy
[ ] Patriot
[ ] Housing & Building violations
[ ] Fire Dept. violations
[ ] Sewer
[ ] Emergency repair
Lender’s Attorney: [ ] Other _____________________
Survey Instructions
[ ] Herewith to read/inspect
[ ] Applicant to provide
[ ] Locate existing
[ ] Order new survey
[ ] Survey endorsement