Tel (407) 977-7200
Fax (407) 971-3000

Email docs@ACTILS.com
E-fax (407) 971-3000

Closing Agent Registration

Step 2: Simply complete the form below to submit your information. All information is completely confidential and there is no obligation on your part.

All highlighted fields are required.

Tell us about yourself:

Name:

First

Middle

Last

Company Name:

Weekday address for document delivery:

Address

Unit

City

State

Zip

Saturday address for document delivery:

Address

Unit

City

State

Zip

SSN:

Phone:

Day phone

Ext.

Evening phone

Phone:

Cellular

Pager

Fax

Messaging & Email:

Text Messaging String

Email address

Best way to contact you:

Nearest relative:

Name

Phone

Have you ever been convicted of a felony or misdemeanor?

yes

Experience:

How long have you been a notary?

Have you notarized loan documents?

yes

Have you notarized loan documents?

Do you have loan signing experience with (select all that apply):

purchases

refinances

lines of credit

List 3 signing services you
currently work for?

Notary Commission & Insurance:

Notary commission:

Number

Expires(mm/dd/yyyy)

Bond Certificate :

Number

Amount

Expires(mm/dd/yyyy)

E & O Insurance
(if applicable)

Insurance

Amount

Expires(mm/dd/yyyy)

Skills:

Are you bilingual?

yes

Languages:

Are you a(n):

To what associations do you belong?:

Equipment:

Accounting Data:

Make checks payable to:

Address check is to be sent to:

Address

Unit

City

State

Zip

CHOOSE A PASSWORD:

Please enter a password that will be easy for you to remember: This password will be used by you to login to our system from

Password

- minimum 6 characters

Confirm Password

- minimum 6 characters

How did you hear about us?

Please make sure that you have completed all questions & then submit.

Personal Information

Tell us about yourself:

Experience:

Notary Commission & Insurance:

Skills:

Equipment:

Accounting Data:

CHOOSE A PASSWORD: