:: Generated By JQueryForm.Com

Do you consider yourself to be an ally and supporter of the ENTIRE Lesbian, Gay, Biseuxal, Gender Non-Binary, Intersex,Transgender, and Queer community?

A "YES" answer is required. If you answer "NO", you do not qualify as a member of the LGBTQ Notary Association.

Yes

No

Membership for LGBTQ-NA is contingent on being a supporter and ally of the ENTIRE LGBTQ population.

Business Name

Business Owner Name

Pronouns

Do you perform notarizations at the address listed above?

Please note: if "YES" is selected, this gives LGBTQ-NA your consent to publish the above-entered address on your business listing so that clients can come to your location of business for notarizations.

Yes

No

Are you a Mobile Notary?

Yes

No

Service Area:

Hours Of Operation:

What is your Phone Number?:

A text message friendly phone number is preferred.

What is your Email?:

Business Description:

Please describe your business.

This field is very important, this will be the main description of your business within your profile. Feel free to be as detailed as possible.

Languages Spoken

LGBTQ-NA Members must be able to speak the English language, please feel free to list all languages you can speak!

Do you carry E & O Insurance?

Yes

No

If you have been Background Checked, please list below:

At least one background check is required.

Business Location Details:

Business Address:

This information will not be made public without your permission.

Business Address Line 2:

This information will not be made public without your permission.

State / District / Territory:

This information will be made public in order to help clients find your notary service.

County, Parrish, or Equivalent (Mark N/A if "Not Applicable")

This information will be made public in order to help clients find your notary service.

City:

This information will be made public in order to help clients find your notary service.

Zip Code:

This information will be made public in order to help clients find your notary service.

What is your business website?:

Feel free to leave it blank if you don't have a website.

Do you offer any discounts?

Feel free to leave this blank if you don't offer any discounts.

Do you offer any Specialty Notary Services?

If the answer is no, please feel free to leave this blank.

Total Notarizations Completed as of now:

If you haven't completed any notarizations mark "0" (Zero)

Make sure to only enter a numeric value.

Total Closed Loan Signings as of now:

If you haven't completed any loan signings mark "0" (Zero)

Make sure to only enter a numeric value.

What documents do you have experience with?:

If you are new and have no experience, feel free to leave this space blank.

Be sure not to just write "loan documents", please be more specific.

What types of technology do you have available to do business with?:

Other Memberships:

Please feel free to leave this blank if you have no other memberships.

Special Certifications:

Please feel free to leave this blank if you do not have any special certifications.

Other Services Offered:

Please feel free to leave this blank if you do not offer any other services.

Payment

USD $157.41

By checking "I Agree" and pressing the "Submit" button, you are agreeing to and acknowledging the following:

1.) The information you are entering into this form is true and correct to the best of your knowledge.

2.) You agree to the Notaries LGBTQ Code Of Conduct.

3.) Your confidence in the handling of your data is essential - we would never share any information input in this form without your express content.

4.) The information you submit will be subject to a review process, and then it will be posted live on our website.

5.) Donation of $157.41 is due immediately in order to start your membership, and you will be billed $157.41 every 2 years until you decide to cancel, upgrade, or downgrade your membership.

6.) Your yearly donation amount is locked in for the next 2 years, we do reserve the right to raise, lower, or remove the fee all together by your next renewal.

7.) Your IP Address is recorded for enhanced server security.

I Agree

Your form has been sent. Thank You! To process your form quicker, please sent a text message to (760) 385-3662