Advocus National | New Member Form

Part I - Personal and Professional Information

Help us get to know you better! Rest assured we will handle all your information with the utmost privacy and security.

Agent Type

I am applying as

An Individual Attorney or on Behalf of a Law Firm A Business Entity

Will Advocus be handling the closing and disbursement of funds for your transactions?

Yes No

NOTE: The State of Wisconsin requires a title license. We can help with that process – let us know if you need assistance.

In some locales, Advocus handles the closing and disbursement of funds at closing on behalf of its attorney agents. If your primary area of business is in one of the following counties, please respond “Yes,” to the question above! Applicable Counties

Office Information

Law Firm or Entity Name *

Office Email *

Office Phone Number *

Office Fax Number

Office Address Line 1 *

Office Address Line 2

City *

County

State *

Zip *

Personal Information

First Name *

Middle Initial

Last Name *

Date of Birth *

Phone *

Email *

Is your home address the same as your office address?

Yes No

Education

Institution Name

Degree

Month and Year

Honors

Delete

Add Education

Bar Admissions (if Applicable)

Bar Admission

Month and Year

Delete

Add Bar Admission

Professional Memberships

Group Name

Delete

Add Membership

Part II - Agency Information

Tell us about your real estate history and previous title agency experience.

General Information

Are you or have you ever been an agent for any other title insurance underwriter?

Yes No

Have you ever had an agency relationship terminated by an underwriter?

Yes No

Number of Expected Closings per Month

Number of Closings in Last 12 Months

Number of Closings in Last 24 Months

Do you have a system for sending encrypted email?

Yes No

Part III - Supporting Information and Documentation

Almost done! We need a few more facts and your consent.

General Information

Are you presently a defendant in a civil suit or have you ever had a civil judgment against you?

Yes No

Have you ever been the subject of a professional disciplinary action or proceeding?

Yes No

Malpractice or Errors and Omissions Insurance

Insurance Policy Carrier

Policy Number

Effective Date

Upload the Declarations page from your current Malpractice or Errors and Omissions policy.

Upload Document

NOTE: Your Advocus representative may ask you to provide additional documentation depending on your location and Agency Type.

Consent to Conduct Criminal Background Search

I hereby grant my consent to criminal background and driving record investigations in connection with my application and agency.

Driver's License Number *

State *

Agreement I certify that the above information is correct and that there are no disciplinary or criminal proceedings pending against me. I will abide by the Advocus National Title Insurance Company regulations, amendments thereto, and prescribed procedures for policy issuance.

Signature of Applicant *

Date *

APPLICATION FOR AGENCY

Questions?
Illinois: 800.252.0402
Wisconsin: 800.788.8989

Part I - Personal and Professional Information

Help us get to know you better! Rest assured we will handle all your information with the utmost privacy and security.

Home Address

Part II - Agency Information

Tell us about your real estate history and previous title agency experience.

Part III - Supporting Information and Documentation

Almost done! We need a few more facts and your consent.

Upload the Declarations page from your current Malpractice or Errors and Omissions policy.

APPLICATION FOR AGENCY

Questions? Illinois: 800.252.0402 Wisconsin: 800.788.8989

Part I - Personal and Professional Information

Help us get to know you better! Rest assured we will handle all your information with the utmost privacy and security.

Home Address

Part II - Agency Information

Tell us about your real estate history and previous title agency experience.

Part III - Supporting Information and Documentation

Almost done! We need a few more facts and your consent.

Upload the Declarations page from your current Malpractice or Errors and Omissions policy.

Questions?
Illinois: 800.252.0402
Wisconsin: 800.788.8989