(logo) Advocus.
APPLICATION FOR AGENCY
We're excited to have you on board.
Questions? Illinois: 800.252.0402
Wisconsin: 800.788.8989
Part I
Part II
Part III
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.
Applicable Counties
×
Illinois
Boone
Champaign
Cook
DeKalb
DuPage
Kane
Lake
Will
McHenry
Ogle
Winnebago
Wisconsin
Kenosha
Milwaukee
Racine
Waukesha
Agent Type
I am applying as
An Individual Attorney or on Behalf of a Law Firm
A Business Entity
Will Advocus or a third-party agency 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
Credit Check - Information
Your Social Security Number
*
Your Personal Phone Number
*
Spouse’s Name (if Applicable)
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
*
- Select State -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
*
Personal Information
First Name
*
Middle Initial
Last Name
*
Date of Birth
*
Phone
*
Email
*
Fax
Is your home address the same as your office address?
Yes
No
Home Address
Address Line 1
*
Address Line 2
City
*
County
State
*
- Select State -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
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
Underwriter
From (Year)
To (Year)
Delete
Add Underwriter
Have you ever had an agency relationship terminated by an underwriter?
Yes
No
Provide a detailed explanation of the agency relationship terminated by an underwriter.
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
NOTE:
American Land Title Association Best Practices recommends that all email messages that contain non-public personal information (NPI) or that have attachments that contain NPI, be sent via encrypted email. Examples of messages and attachments containing NPI include but are not limited to Closing Disclosure Forms, title commitments and policies, and title search cover pages.
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
Provide a detailed explanation including the case number, court in which the case was filed, circumstances, and disposition.
Have you ever been the subject of a professional disciplinary action or proceeding?
Yes
No
Provide a detailed explanation of the circumstances and disposition.
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
*
- Select State -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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
*
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