Request for Witness Services
Date
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Month
-
Day
Year
Date
Admin ONLY:
For Office use ONLY- Clients, leave blank.
Section 1- Individual
Complete this section them move to section 3 if you are an individual requesting service.
Name
First Name
Last Name
cw_client_name
cw_company_name
Phone
Please enter a valid phone number.
Email
Please enter a valid email
Section 2- Company/Entity/Third Party
Complete this section then section 3 if you are a company/entity/third party requesting service.
RC Mode (Hidden)
Company
Name of Company requesting service.
Company Phone
Company Email
Your Customer's Name (For Internal Reference Only)
First Name
Last Name
cw_company_name
cw_client_name
Section 3
Please complete then submit your request.
Number of witness(es) needed
*
1
2
White Rose Notary Services LLC
Service Address
*
Service Address Re-typed
Please re-type to ensure accuracy
Fee/mile
parentSubmissionId
Document requires Witnesses
requestorCategory
jobType
Appointment
*
Witness Fee calculation
Agent Fee
*Witness fee: $35 per person + $0.725 per mile round-trip.*
Payment required in advance.
Scheduling Fee
Required prior to scheduling and will be subtracted from final fee. May pay full fee if desired.
How would you like to pay? (Single Choice)
Cash
Cash App (Submit in apps via $whiterosenotary)
Apple Pay (Submit on phone using 301-830-0043)
Google Pay ( submit using fbbnotary@gmail.com)
Zelle (Submit in app using 301-830-0043)
Venmo( submit in app using @whiterosenotary)
Credit Card ( See below)
Company Portal/Internal Billing
Pay Later/Invoice (Approved Entities ONLY)
override
White Rose Notary Services LLC
Please Add any other pertinent order details:
fbbnotary@gmail.com
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USD
Description
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
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