Attorneys Title Guaranty Fund, Inc.
Title Insurance Claim Submittal Form
Please select your states:
------ PLEASE SELECT ------
Alabama
Arizona
Colorado
Louisiana
Maryland
Mississippi
Montana
Minnesota
North Dakota
Nevada
Ohio
Tennessee
Utah
Please provide your policy number (if any):
Please provide the following information. All fields marked with
*
are required for submission:
*
A. Your Contact Information
Full Name:
Address:
Email Address:
Telephone Home:
Cell Phone:
Work Phone:
Preferred Contact Method:
Email
Mail
Home Phone
Cell Phone
Work Phone
B. Property Information
Full Address:
,
Purported Insured:
*
Tax Serial/ID #:
Your Interest in Property:
Owner
Lender
Other
If other, please describe:
C. Title Agent Name and Address (title agent who handled your transaction):
Title Agent Name:
Full Address:
*
D. Describe the nature of the title problem:
E. Have you been sued or threatened with a lawsuit relating to this matter?
Yes
No
F. Have you been served with any kind of petition or legal document?
Yes
No
If yes to either E or F, please include copies of all documents served upon or otherwise received by you.