For Sale By Owner Real Estate Sale

This application is for the Seller or Seller's Attorney to complete in an FSBO situation. If you would prefer to download the PDF verison of this form, click here.

Rates

Refer to Title Insurance Rate Schedule for the current Wisconsin title insurance rates. Assurance Title charges $150.00 to prepare the Seller's Closing Statement.

Mention "AT-Coupon" in the "Special Instructions" box in the application below and receive $25.00 off this rate.

Before Completing Application

Assurance Title will need to be provided with the following two (2) items to process the title insurance and prepare the Seller's Net Closing Statement:


Application for Title Insurance:
For Sale By Owner Real Estate Sale

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."

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Applicant Information

Name of Person Placing Order:(*)
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Name of Company:(*)
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Email:(*)
Please enter a valid email address.
Billing Address:(*)
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Billing Address 2
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Billing City:(*)
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Billing State:
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Billing Zip(*)
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Phone(*)
Please enter a valid phone number (xxx-xxx-xxxx)
Date Needed By:(*)
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Fax:
Please enter a valid fax number (xxx-xxx-xxxx)
   

Seller Information

Seller's Full Name:(*)
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Is the subject property the seller’s primary residence:(*)
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Current Address:
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(if different from property address)
Seller's Current Lender:
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Buyer Information

Buyer's Full Name:(*)
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Buyer's Current Address:(*)
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Buyer's Phone:(*)
Please enter a valid phone number. (xxx-xxx-xxxx)
Buyer's Email Address:
Please enter a valid email address.
Buyer's Lender
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Lender Phone:
Please enter a valid phone number. (xxx-xxx-xxxx)
Buyer's Loan Officer:
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Loan Officer Email Address:
Please enter a valid email address.
Loan Amount:
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Loan Type:
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Requested Endorsements:
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Proposed Insured:
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Property Information

Property Address:(*)
Please enter a property address.
Sale Price:(*)
Please enter sale price
Anticipated Closing Date(*)
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Property Type:(*)



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How many parcel(s) does the subject property contain?(*)
Please enter only numbers.

To receive discounted Re-Issue Rate, please upload your existing title policy.

If you cannot upload, please email a PDF of the policy to us at This email address is being protected from spambots. You need JavaScript enabled to view it.. If scanned images are not possible, please fax the title policy to (920) 235-2122 or drop it off at our office.
Prior Title Evidence:(*)
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Upload File:
File types accepted: PDF, JGP, or JPEG under 500KB
File types accepted: PDF, JGP, or JPEG under 500KB
Known Conditions of Title:
(Shared driveway, shared well, easements, etc.)
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Attorney for Seller:
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Attorney for Buyer:
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Special Instructions:
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Necessary Information

Assurance Title will need to be provided with the following two (2) items to process the title insurance and prepare the Seller’s Net Closing Statement:
  • A fully executed Offer to Purchase, Addendums, Counters or Amendments.
  • A completed Authorization to Release Confidential Information.
Please upload fully completed, scanned PDF images of these two (2) items now.

These forms can be downloaded here.

File types accepted: PDF, JPG, JPEG Max file size: 500KB
If scanned images are not possible, please fax them to: (920) 235-2122 or they can be dropped off at our office. If you need assistance, we are just a phone call away, please call our office at (920) 235-0017.
Upload Authorization to Release Confidential Information
File types accepted: PDF, JPG, JPEG Max file size: 500KB
Upload Offer to Purchase
File types accepted: PDF, JPG, JPEG Max file size: 500KB
Upload Addendum, Counter, or Ammendment:
File types accepted: PDF, JPG, JPEG Max file size: 500
I have more files to upload (Addendums, Counters, or Amendments)
Invalid Input
Upload Additional Files:
File types accepted: PDF, JPG, JPEG Max file size: 500
File types accepted: PDF, JPG, JPEG Max file size: 500
File types accepted: PDF, JPG, JPEG Max file size: 500
File types accepted: PDF, JPG, JPEG Max file size: 500
File types accepted: PDF, JPG, JPEG Max file size: 500
If you have additional files, please email them to This email address is being protected from spambots. You need JavaScript enabled to view it..

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:

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We have endorsed and adhere to the "Title Insurance and Settlement Company Best Practices Policies".