Thank you for wanting to sign up with the Maine Notary Net. This short form, when submitted, will serve as an interest only application unless submitted with a payment. We will call you within two(2) business days of our receipt for a telephone interview to explain the service and concept of the network. When this form is completed, sent it to: Kevin M Carman Maine Notary Net 178 Ohio Street Apt 1 Bangor, ME 04401-4740 Name: _____________________________________________________ (This must be the same name as your Maine Notary Public Commission [For verification Purposes]) Town of Residence: _____________________________________________________ (The Town of Residence is required for verification purposes only) County of Residence:____________________________ (needed for Membership ID Creation) Contact Numbers: (home) #: ____________________[____] (work) #:______________________[____] (Cell) # ___________________________[____] Cell Carrier ________________________ [used for text paging for your voicemail on the system) (This is the number you want clients to call for your services [if no area code is entered 207 is assumed]) Our system can be set to call your Primary cell and any other numbers simultaneously. Indicate this by a check mark by the numbers you want to be auto-called for you. -- If you want the system to be able to call you, but not published on your Details page, place a 'U' at the end or the number. Fax #: ____________________________________________________ (If you have one - also state if it is used for fax Docs) Current Email Address: ____________________________________ (yahoo, hotmail, gmail addresses do not really look professional in our opinion and have restrictions on attachment sizes, consider a mainenotarynet.org address in these cases) _______ I would Like a mainenotarynet.com email address for an additional $5.00/yr. The name patterns available are f+lastname, f+m+Lastmname, first.lastname or currentbusinessname - you choose e.g. jschmo, jqtaxpayer, john.taxpayer, johnsspeedysignings Preferred address: ________________________ Current Professional Website: ___________________________________________________________ (This is not for free personal pages as offered by most ISP's - e.g. http://members.yourisp.com/~yourname/ [these can get complicated] or the like. This is for websites you own and have related content on. e.g http://www.onestopnotaryme.com) Please Select all that apply -- Counties that you cover _____ 101-Androscoggin (A) _____ 105-Hancock (E) _____ 109-Oxford (J) _____ 113-Somerset (P) _____ 102-Aroostook (B) _____ 106-Kennebec (F) _____ 110-Penobscot (K) _____ 114-Waldo (R) _____ 103-Cumberland (C) _____ 107-Knox (G) _____ 111-Piscataquis (M) _____ 115-Washington (S) _____ 104-Franklin (D) _____ 108-Lincoln (H) _____ 112-Sagadahoc (N) _____ 116-York (T) If there are any counties you only partially cover, Check them above, then list the county and the towns you cover within it in the space below, with each county on a separate line. You may also use the County Codes listed above if you wish For example: (Use the back if you need more space) Pascataquis - Dover-Foxcroft, Brownville K - Bangor Area, Lincoln, Millinocket ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Check if any apply to you: (These options will put you in the different categories on the website _____ I am a Dedimus Justice (Dedimus Justices may list for free for life as long as they are in office) [Deimu only listings are marked as 117 and IDs starting with Y] _____ I love to do weddings _____ I am a Notary Signing Agent (Mobile Notary) [Mortgages, refI, etc.] ____ I provide 24 Hour Service (optional) I would also like to join now We offer multi-year plans for those whom wish to sign up this way. Our idea was to have your expiration on this site match the expiration of your commission, at least the date, if not the year as well. This way when you renew you commission you might renew here as well. The more years you subscribe for, the less the per year cost. Choose the Plan that is right for you: _____ 1 Year - $24.00/Year ($24.00) - (2.00/Month) _____ 2 Year - $22.00/Year ($44.00) - (1.83/Month) - save $ 4.00 over per year cost. _____ 3 Year - $20.00/Year ($60.00) - (1.66/Month) - save $12.00 over per year cost. _____ 4 Year - $18.00/Year ($72.00) - (1.50/Month) - save $24.00 over per year cost. _____ 5 Year - $16.00/Year ($80.00) - (1.33/Month) - save $40.00 over per year cost. _____ 6 Year - $14.00/Year ($84.00) - (1.16/Month) - save $60.00 over per year cost. _____ 7 Year - $12.00/Year ($84.00) - (1.00/Month) - save $84.00 over per year cost. ** Best Value (7th year is Free) ** Sign up for 5 years or more and receive a free Maine Notary Net email address (a minimum $25.00 value) This completes the short form application. Upon receipt by this office we will contact you for payment instructions and a telephone interview within two(2) business days - usually same day in most cases. Again this is interest only until payment is received (you may submit payment now if you wish) Please remit by Money order/check the amount of: _____ Membership fee (see fee next to your choice) _____ Email address $5.00 Year (if 5yrs or more write FREE) _____ Total Enclosed payable to Kevin M Carman (we had to drop our business account when the fees cost more that the yearly checks cashed on it) to the address indicated above, or fill out the form and call 207-307-2500 ext 51901, or fax it to 207-770-1800 because we can take credit cards through paypal using our paypal email of mainenotarynet(dot)pbx(at)gmail(dot)com or over the phone / in-person through Square for you to send in the fee in these forms. Thank you for your interest. Maybe this will turn into something good. Kevin M Carman Maine Notary Net - Founder & President