Vendor Application Form

ATC Vendor Application Form July 2012

Thank you for your interest in becoming a Notary Signing Agent for ATC. In order to be considered for approval, please fill out the form below:

Agent Information
Name * First Last
Please include your middle initial in the first name field.
Email Address *
Company (if applicable)
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone Number * - (###) - ### ####
Mobile Number - (###) - ### ####
Fax Number - (###) - ### ####
Do you have a smartphone? * Yes No
What is the best method to contact you for a signing? * Phone Call Text Message Email
Background and Experience
How long have you been doing closings? (Minimum of 2 years required)
How many loans have you closed in the past year?
Please list the Lenders/Banks you have closed for:
What counties do you service? *
Please list your fee (including e-docs) * $ . Dollars Cents
Please make us aware of any additional fees that you may charge.
Languages Spoken (other than English)
Days/Hours Available
What types of loans have you closed?
Do you know how to explain all bank documents? * Yes No
i.e. HUD, mortgage and note? Training may be provided for documents you are unfamiliar with.
Do you have a Title Insurance Producer's License? * Yes No
This is required in certain states
Licensing Information
Notary Commission/License Number *

Please note that we will need a copy of your License on file.
State *
Expiration Date * / MM / DD YYYY
Do you have Professional Errors and Omissions Liability Coverage? Yes No
E&O Expiration Date / MM / DD YYYY
Please send copies of E&) if applicable.
Do you currently, or have you had within the past 5 years, any claims or judgements filed against you relative to a real estate transaction?

If yes, please submit a detailed explanation.
References (Please submit 3)
Company Name
Contact Name First Last
Phone - (###) - ### ####
Company Name
Contact Name
First Last
Phone - (###) - ### ####
Company Name
Contact Name First Last
Phone - (###) - ### ####
Electronic Signature
I acknowledge that all requested information has been filled out to the best of my ability and is a true and accurate represenation of my experience and skills. * I accept

Vendor Application Form

ATC Vendor Application Form July 2012

ATC Vendor Application Form July 2012

Agent Information

Background and Experience

Licensing Information

References (Please submit 3)

Electronic Signature