DINAH STALLWORTH - SIGNING SERVICE

Application for Approval as a Notary Signing Agent
* Indicates a required field

First Name

Last Name

Cell Phone Number

Home Phone Number

Fax Number

Email Address

Mailing Address

Street Address

City

State

Zip

Document delivery address (if different then above)

Street Address

City

State

Zip

Experience as a Notary

# of Loans Closed

Are you a certified Signing Agent? Yes No

If Certified, Whom are you certified by?

Commission #

Notary Bond Number

Notary Bond Expiration Date

Do you have E & O Insurance? Yes No

E & O Carrier

E & O Coverage Amount

Do you have a printer? Yes No

Printer Model and Number

What type of internet connection
do you have?

Laser Printer Yes No

Parishes Covered

Primary or Home Parish

Additional Parishes Covered

What are your hours of availability
(Please provide days, hours etc.)

Please list what your fees are for the following

Single Loan (Email Documents)

Single Loan (Overnight Delivery)

Double Loan (Email Documents)

Double Loan (Overnight Delivery)

HELOC ( Email Documents )

HELOC ( Overnight Delivery )

Settlement Funding ( Email Documents )

Settlement Funding ( Overnight Delivery )