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Affiliates
* Required fields  
*Name
*Company
*Address
 
*City *State   *Zip
*Fax Number *Cell Phone   
*Work Phone  *Home Phone 
*Email  
 
*Coverage Area
  Please provide a brief description of the requested primary
coverage area by state and either county or city.
 
 
*Work Experience/Education
  How long have you been a notary public?
 
  How long have you been a signing agent?
 
  How many loan signings have you done in the last year?
 
  What types of loan signings have you done?
 
  Can you provide references for signing work?                    No Yes
  If yes, please provide:
 
*Name

*Phone
Name
Phone
Name
Phone
  What industry designations have you acquired?
  Please describe your industry-related work experience.
  What is your availability for signings?
  What is your average signing fee?
 
*Technological Capabilities
  Do you have the capability to receive e-docs? No  Yes
 
Which types of hardware do you have access to?
 

High Quality Printer

Fax Machine

     Letter size

Scanner

     Legal size

  
 
Which types of software do you have access to?
 

High Speed Internet

Adobe Acrobat

Word Processing

Email

Swiftview

  
Have you ever been convicted of a felony, misdemeanor or any public offense having as one of its elements a fraudulent or dishonest act? Yes No
The foregoing application has been completed by me to induce Fiserv Lending Solutions to approve me as a Fiserv Lending Solutions Affiliate. I hereby certify that the answers and statements made are true and correct to the best of my knowledge and belief. In connection with my application, I understand that my references will be contacted.
   

    

 
 
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