FIRST NAME
LAST NAME
HOME ADDRESS
ZIP CODE
STATE
Please note: We are only able to process applications for the States listed in the drop down
CITY
DATE OF BIRTH
SOCIAL SECURITY NUMBER
RESIDENCE TYPE
TIME AT RESIDENCE
HOME PHONE
MOBILE PHONE
EMAIL

  1. Communication Consent
    Email and Telephone Policy
    I understand that any communication received from Lake Title may be accessed by anyone with access to my email address or telephone. I am responsible for securing access to my devices and email address. If I change my contact details or transfer my device to another person, I will notify Lake Title immediately.
    1. Email Consent:
      By providing my email address, I give my express written consent and authorization to Lake Title, its affiliates and service providers to send emails related to my account and marketing offers to the email address I provided.
    2. Telephone Consent (Calls and Voicemails):
      By providing my telephone number, I give my express written consent and authorization to Lake Title, its affiliates and service providers to call or leave voicemail messages related to my account and marketing offers at the telephone number I provided.
    3. SMS/Text Consent:
      By providing my cell phone number and checking the box, I give my express consent and authorization to Lake Title, its affiliates and service providers, to send SMS/text messages related to my account and marketing offers to the contact number I provided. This includes important account notifications and marketing messages. Message and data rates may apply according to my cellular provider’s terms.
    4. Message Frequency: Message Frequency varies.
    5. Opt-out:
      1. SMS: To stop receiving text messages, I can reply "STOP" to any message received. I understand that my opt-out request will become effective immediately.
      2. Opt-Out of Email: To stop receiving marketing emails, I can click the "unsubscribe" link included at the bottom of any email message from Lake Title or its affiliates and service providers. I understand that my opt-out request will be processed within ten business days
      3. Help: If I need help with SMS messages or email communications or further assistance, I can reply "HELP" to any message or contact Lake Title directly at (352) 692-2274 or via email at [email protected].
  2. Data Sharing Disclosure
    I authorize Lake Title to pull consumer data from third-party sources and consumer reporting agencies as part of this application and for future services. This includes validating my identity, military status, or credit information (excluding Alabama, where specific state laws may limit credit checks) as permitted by the Fair Credit Reporting Act (FCRA) and the Servicemembers Civil Relief Act (SCRA). I understand that Lake Title and its affiliates only works with service providers, and these service providers have their own policies regarding the handling, sharing, and use of my information. If I wish to stop receiving communications or marketing offers from any service providers, I must contact them directly to opt-out. For more information on how Lake Title handles data, please refer to our Privacy Policy.
  3. Electronic Signatures and Communication
    I consent to use electronic records and signatures in my transactions with Lake Title. This includes accepting documents, disclosures, and notices electronically for this and any future transactions which I can print and save for my records. I understand that I must have access to a computer or device with an internet connection, a compatible web browser, and software to read PDF files to use electronic records and signatures. I have the right to withdraw this consent by contacting Lake Title, although withdrawal may limit my ability to access electronic services, inkling the receipt of electronic notices or disclosures.
  4. Confidentiality and Intellectual Property
    All communications with Lake Title regarding this transaction are confidential, except as required by law. Any emails, feedback, information, or materials submitted to Lake Title through this website ("Submissions") will be deemed Lake Title’s property. By providing Submissions, I assign all worldwide copyrights and intellectual property rights to Lake Title and its affiliates and service providers.
  5. Bank Account Information Use
    If credit is extended to me, I agree that any bank account information I provide will be used for authorized payment processing. I understand that Lake Title will protect my bank account information in accordance with applicable privacy and security laws.

Telephone Number:

Customer:

Date: 07/03/2025