Clone of Remote Online Notarization Intake Form

First Name

Last Name

E-mail

Phone

Type or Name of Document(s)

(example: Power of Attorney, Travel Consent Form, Retirement forms, Passport Form (DS-3053), VIN Verification form, etc.)

How many notarizations (notary stamps) are needed?

(each signature requiring notarization counts as one notarial act. $10 per notarial act)

Are witnesses needed?

Where will the notarization take place?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Appointment

MOBILE NOTARY PRICING

$10 per notarization (each stamp) + travel fee.

Travel Fees (distance calculated from 4495 Roosevelt Blvd, Jacksonville, FL 32210)

• 0–10 miles: $35
• 11–20 miles: $65
• 21–35 miles: $85
• Over 35 miles: Contact for quote

Booking Deposit: A $35 non-refundable booking deposit is required to secure your appointment and will be applied toward your final appointment total.

Witness Fee (If Needed): $25 per witness provided by Notary Prime LLC. Witness fees are paid in advance and are non-refundable once the witness has been scheduled for your appointment.

Booking Deposit

Required to secure your appointment. Non-refundable and applied toward your final appointment total.

$35.00

Witness Fee (If Needed) — Per Witness

Only applies if you request a witness provided by Notary Prime LLC. Witness fees are non-refundable once the witness has been scheduled for your appointment.

$25.00 Quantity

Total

Payment Methods
Credit Card Number	Security Code
Expiration Month	Expiration Year

Comments

Mobile Notary Services