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)

Primary Contact #: ________________________________________________
(This is the number you want clients to call for your services [if no area code is entered 207 is assumed])

Fax #: ____________________________________________________

Current Email Address: ____________________________________

	_______ I would Like a mainenotarynet.com email address for an additional $2.00/yr.
	The name patterns available are f+lastname or f+m+Lastmname - you choose
	e.g. jschmo or jqtaxpayer

		Prefered address: ________________________

	_______ Attach my Maine Notary Net email address to my Yahoo! ID _______________________
		(by attaching to your Yahoo ID you set your password [same as your Yahoo! password]
		If not attached to a Yahoo ID the home office is the only one to set/reset a password. 
		Also can only be used with an email client such as Outlook, Netscape Communicator, etc.
		and is not available on the web)

Current Professional Website: ___________________________________________________________
(This is no 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

_____ 1-Androscoggin     _____ 5-Hancock     _____ 9-Oxford          _____ D-Somerset
_____ 2-Aroostook        _____ 6-Kennebec    _____ A-Penobscot       _____ E-Waldo
_____ 3-Cumberland       _____ 7-Knox        _____ B-Piscataquis     _____ F-Washington
_____ 4-Franklin         _____ 8-Lincoln     _____ C-Sagadahoc       _____ 0-York

If there are any counties you only partially cover, Check them abovethen 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
A - Bangor Area, Lincoln, Millinocket

___________________________________________________________
___________________________________________________________
___________________________________________________________

Check if any apply to you: (tThese 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)
_____ I love to do weddings
_____ I am a Notary Signing Agent (Mobile Notary) [Mortgages, refI, etc.]
	____ I provide 24 Hour Service (optional)

<End Signup>

I would also like to join now

We offer multi-year plans for those whom wish to sign up this way. 
My 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.

Sign up for 5 years or more and receive a free Maine Notary Net email address (a minimum $10.00 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 interst 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 $2.00 Year (if 5yrs or more write FREE)

_____ Total Enclosed

payable to Maine Notary Net to the address indicated above, or fill out the form and call 207-949-1492

because I can take credit cards through paypal using paypal@mainenotarynet.com for you to send the fee in this form.

Thank you for your interest. Maybe this will turn into something good.

Kevin M Carman