* - Required Field

$5,000 Arizona Notary Bond
$5,000 Errors and Omissions Policy
2000 + Self-Inking Notary Stamp
Approved Notary Journal
All State and County Filing Fees
State Submission and Application Status
Free Shipping

Notary Stamp Ink Color
* Black Blue Purple Turquoise

Name to appear on bond

Your Social Security Number
* xxxxxxxxx

Requested effective date

*Business Mailing Address (REQUIRED AND IS A PUBLIC RECORD)

*Home Mailing Address

Which address would you like your certificate and supplies to be shipped to?

* Business Home

Gender
* Select. Male Female

*Your Home phone number

*Your Business phone number

Your fax number

Your e-mail address
*

Please answer the following Questions?

*1. Have you ever been convicted of a felony OR a lesser offense involving moral turpitude of a nature that is comparative with the duties of a notary public?
Please Select One Yes No
If the answer to #1 is "Yes," have you had your civil rights restored?
If "Yes", you MUST provide proof of the restoration of your civil rights AND documentation regarding the nature of your conviction and/or offense.

*2. Have you ever had a professional license revoked, suspended, restricted, or denied for misconduct, dishonesty, or any cause that substantially relates to the duties or responsibilities of a notary public? If yes, please explain below.
Please Select One Yes No
Explanation Box

*3. Have you ever had a notary commission revoked, suspended, restricted, or denied in this state or any other jurisdiction? If yes, Please explain below.
Please Select One Yes No
Explanation Box

*4. Are you 18 years of age or older?
Please Select One Yes No

*5. Are you a citizen or a legal permanent resident of the United States?
Please Select One Yes No

*6. Do you claim Arizona as your primary residence for state and federal tax purposes?
Please Select One Yes No

*7. Have you been commissioned as a notary public in any other state or jurisdiction?
(if "yes", Please specify the location(s) below.

Please Select One Yes No
Enter Locations Below


*8. Are you bilingual? (If "yes", Please list the languages below)
Please Select One Yes No
Enter Languages Below (If Bilingual)

Found Us How?

*found how Please Select One Direct Mailing Radio Advertisement Kudzu.com Business.com Google MSN Yahoo Ask.com Other Search Engine Other Way
If other way Please Specify

(Optional Questions)
Are you happy with your Auto Insurance Rate?
Please Select One Yes No

Would you be interested in Saving Money?
Please Select One Yes No

May we contact you in the near future regarding these questions?
Please Select One Yes No Yes in 1 Month Yes in 2 Months Yes in 3 Months