ATG
®
Initial Membership Application Form
For your protection, a Member Services Representative will contact you to collect additional information.
Personal and Professional History
(all fields required)
Name
Office Street Address
City
State, Zip
E-mail
County
Phone (with area code)
Fax (with area code)
I am applying for (check one)
membership (
a shareholding member who issues title insurance through ATG, fee applies
)
non-member agency (
issues title insurance but is not a shareholding member, no charge
)
Licensed in
Illinois
Indiana
Wisconsin
Education
Memberships
Authorship
References
If you were ever an agent for any other title insurance underwriter, please type the information for each agency below. If not, please type "not applicable" below:
Underwriter
From
(year)
To
(year)
# closings
per month
# closings
in last
12 months
# closings
in last
2 years
[Last update: 3-21-08]
