NOTARY APPLICATION ORDER FORM

Notary Insurance Services, Inc.

4107 South 1st Street
Austin, Texas 78745

Phone: 512.443.9202
Fax: 512.707.7115

Required Bonding & State Filing Fee
$71.00
Official Journal & Fee Chart
$15.00
Handbook, Updates & Decal
Free
Embosser or Pre-ink Stamp
$24.00
Special Discount Offer! 3/5 UPS Delivery
Total    $110.00

Yes! Process my bond and file my notary application. Enclosed is my payment of:

$71.00 ($50.00 bond fee and $21.00 state fee)

or

$110.00 for package offer.

[    ] Check enclosed-Payable to Texas State Notary Bureau

Please charge $______________ to the following credit card:
[    ] VISA [    ] Mastercard [    ] Discover [    ] American Express

NAME ON CREDIT CARD: _________________________________________________________________

SIGNATURE: ___________________________________________________________________________

CREDIT CARD NO. ______________________________________________________________________

CARD EXPIRES: ________________________________________________________________________

Notary Name __________________________________________________________________________
(Order will be processed with name indicated)

Company Name _________________________________________________________________________

Business Address (no PO Boxes)________________________________________________________

City/State/Zip _______________________________________________________________________

Business Telephone ( __________ ) ____________________________________________________

Home Telephone ( __________ ) ____________________________________________________

[    ] Please send Texas Notary Public Handbook, the Law Update and program information on the Texas State Notary Bureau.

[    ] Please send package via Priority Mail to address listed. I accept responsibility for lost or misdirected package.

$20.00 processing fee is non-refundable.