This application is for placing a title insurance order for a residential refinance Expedited loan policy. Expedited search refinances do not include a search of easements and restrictions and can only be used on residential properties.

If you would prefer to download the PDF verison of this form you can do so here: 

Title Rate

For current Wisconsin filed title rates, please contact our office.

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Application for Title Insurance:
Refinance Expedited Loan Policy

Directions:  To ensure accuracy, please complete all asterisk items below and as many of the non-asterisk items to assist us in completing the title order process.

All supplied information will be kept strictly confidential.
Assurance Title complies with the ALTA Best Practice Policies. View our "Privacy Policy Notice."

	Applicant Information
Name of Person Placing Order:(*)	Invalid Input
Lending Institution:(*)	Invalid Input
Email:(*)	Please enter a valid email address.
Billing Address:(*)	Invalid Input
Billing Address 2	Invalid Input
Billing City:(*)	Invalid Input
Billing State:(*)	Invalid Input
Billing Zip(*)	Invalid Input
Phone(*)	Please enter a valid phone number (xxx-xxx-xxxx)
Date Needed By:(*)	... Invalid Input. Please use MM/DD/YY format for date
Fax:	Please enter a valid fax number (xxx-xxx-xxxx)
	Expedited Loan Policy Information
Loan Reference Number:	Invalid Input
Loan Amount:(*)	Invalid Input
Loan Type:(*)	Invalid Input
Property Owner Name(s):(*)	Invalid Input
Property Address:(*)	Please enter a property address.
Proposed Insured:(*)	Same as above To read as follows: Invalid Input
	Invalid Input
Anticipated Closing Date(*)	... Invalid Input. Please use MM/DD/YY format for date
How many parcel(s) does the subject property contain?(*)	Please enter only numbers.
Legal Description or Parcel ID/Tax Key Number:	Invalid Input
Requested Endorsements:	Invalid Input
Special Instructions:	Invalid Input
	Important: Upon completion of the above order form you will receive an email confirmation that we have received your title order request. If you do not receive the confirmation, please contact us at (920) 235-0017.
(*)
Submit this Application:	Submit