WLT Title Insurance Application

TITLE INSURANCE APPLICATION FORM

Use the tab key to navigate and complete all fields before submitting

PROPERTY INFORMATION

ADDRESS: CITY: STATE: ZIP:

TOWNSHIP/BOROUGH: COUNTY:

TAX PARCEL NO.: SALE PRICE:

SELLER INFORMATION

NAME(S):

ADDRESS: CITY: STATE: ZIP:

PHONE: FAX: EMAIL:

BUYER INFORMATION

NAME(S):

ADDRESS: CITY: STATE: ZIP:

PHONE: FAX: EMAIL:

LENDER INFORMATION

INSTITUTION NAME:

ADDRESS: CITY: STATE: ZIP:

PROCESSOR:

PHONE: FAX: EMAIL:

PAYOFF INFORMATION

PAYOFF 1: ACCOUNT NO.:

PAYOFF 2: ACCOUNT NO.:

SELLING AGENT & OFFICE:

LISTING AGENT & OFFICE:

SETTLEMENT DATE: CONVEYANCING:

SPECIAL INSTRUCTIONS:

FOR OFFICE USE ONLY: DATE: FILE NO.:

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