Closing Vendor Application Form

General Information
*Name:
*Email Address:
 
ALL VENDORS MUST BE ABLE TO RECEIVE ALL ASSIGNMENTS AND STATUS UPDATES VIA EMAIL.
 
*Contact Name:
Street Address: City:
State: Zipcode:

Telephone Numbers
Office:
- -
Home:
- -
Pager:
- -
Cell:
- -
Fax:
- -
Other:
- -
*Can you accept a loan package via email?
Yes No

Qualifications
*Fed Tax ID:
*SSN:
*Are you currently carrying Errors & Omissions insurance on your work?
Yes No
If yes, with which company?
Amount of coverage: $
Expiration Date (MM/DD/YY):

Activity Areas
Primary County:
Primary State:
List all counties where you feel qualified to complete work. Please note any city exclusions and list the zip codes if applicable:
Maximum Daily Orders
*Maximum daily orders you can accept from us: 

Fee Schedule
Please indicate what fees you will charge Urban Settlement Services, Inc. for the following services:
*Witness Only Fee:		 $
*Trip Fee: $
*Notary Closing Fee: $
Additional Fee Information: