Please complete the below for emergency notarizations. We provide onsite, mobile and remote online notarizations. Upon completion a Notary Public will be paged and contact you.

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Current Date / Time *

Date

Time

Name *

First

Last

Phone Number *

Email *

Service Requested *

• Standard INK Notarization
• Remote/ Online Notarization
• Loan Signing Documents
• Unsure

Location Requested *

• Our Location in Atlantic City
• Remote / Online
• Your Location (please indicate address in below)

Type of Document to be notarized *

Do you need any forms or templates provided to you *

• YES
• NO
• UNSURE

Does all persons signing the document have a valid unexpired state government photo ID or Passport? *

• YES
• NO

Is the person signing the document of sound mind *

• YES
• NO

If Remote Online is requested is there a desktop or laptop computer with internet, audio and video capability that the signer can access *

• YES
• NO
• N/A

Is the person signing the document in a healthcare facility *

• YES
• NO

Location requested for signing

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Date &Time Requested for Signing *

Date

Time

I understand this an Emergency Request and we will do our best to accommodate and I am aware that there is a fee associated with this *

• YES
• NO

Additional Information

Visual Code

File Upload (if unavailable a secure link will be provided)

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 50 files.

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3

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AC Mobile Notaries are not  attorneys licensed to practice law and may not give legal advice about immigration or any other legal matter or accept fees for legal advice

or is for

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