Remote Online Notary Request

Remote Online Notary Request

Let us know how we can help you!
Section 1: Contact Information

Person Booking
Full Name of Person Requesting Service

First NameLast Name
Relationship to Signer
If other, please describe
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Perferred Method Of Communication
Section 2: Resident/Signer Information
Full Name of Resident (Signer)

First NameLast Name
Is the Resident the Person Signing the Document?
If No, Please explain
How Many People Need Notarization?
Signer Email Address(optional)
example@example.com
Will any Witnesses Be Required?
Section 3: Appointment Location
Signing Location Address

Building Name and Street Address (include ROOM NUMBER)

Street Address Line 2

CityState / Province

Postal / Zip Code
Facility Contact Person (Nurse/Admin)
Resident Room Number/Wing
Facility Phone Number
Are there any Entry Instructions?
Section 4: Document Details
Type of Document Being Notarized
Other:
How many Documents Need Notarization?
How Many Notarial Stamps are Needed? (if known)
Will the Document Be Ready at the Appointment?
Would you like Printing Services?
Upload Documents Here (Optional)

Cancelof
Section 5: Signer Awareness & Capacity Screening
Is the Resident Alert and Aware Enough to Sign Willingly?
Has the Resident Been Diagnosed with Dementia or Cognitive Impairment?
Will the Resident be able to Communicate Directly with the Notary?
Is anyone Pressuring the Resident to SIgn?
Section 6: Identification Requirements
Does the Resident Have a Valid Government Issued Photo ID?
Type of ID available
If No Valid id: Would Credible Witness Be Available?
Section 7: Scheduling

Request Appointment Date
Is This Urgent/Same-day?
Any Facility Restrictions on Visit Times?
What date and time work best for you?
Any other specific date and time, if the above selection is not suitable.

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
If you'd like to provide extra information:
Section 8: Payment Information
Who will be Responsible for Payment?
Preferred Payment Method
Do You Approve Travel Fees For Mobile Service?
Final Acknowledgement, by signing below I understand the signer must be willing, aware and able to communicate for notarizations to proceed.
Additional Notes or Special Requests
Other Services provided by the notary
Should be Empty:

Remote Online Notary Request

Section 1: Contact Information

Section 2: Resident/Signer Information

Section 3: Appointment Location

Section 4: Document Details

Section 5: Signer Awareness & Capacity Screening

Section 6: Identification Requirements

Section 7: Scheduling

Section 8: Payment Information