MICHIGAN LAND TITLE ASSOCIATION



| |

|MICHIGAN LAND TITLE ASSOCIATION |

|Affiliated with American Land Title Association |

|124 W. Allegan, Suite 1700 |

|Lansing, MI 48933 |

|PHONE: 517-374-2728 ∙ FAX: 517-908-0079 |

|e-mail: ED@ |

|website: |

| |

|APPLICATION FOR MEMBERSHIP |

|(Please Print or Type) |

| |

|Business Name: |

| |

|Business Address: |

| |

|City: County: State: Zip: |

| |

|Telephone No.: Fax No.: |

|Email: _________________________________ Website: _______________________________ |

| |

| |

|Applicant is: Incorporated Sole Proprietor Partnership            |

| |

|If Incorporated, Date of Incorporation: |

| |

|State of Incorporation: |

| |

| |

|Active Officers, Proprietors or Partners, and Owner: |

| |

|Name: Title |

| |

|Name: Title |

| |

|Name: Title |

| |

|Name: Title |

| |

|Owner’s Name: |

| |

| |

|Applicant is applying for membership as: (See Bylaws, Article III.) |

| |

|□ Abstractor/Agent/Associate □ Associate Member □ Underwriter |

| |

|Primary County Served: |

| |

|Other Counties Served:: |

| |

| |

| |

| |

|MLTA Application for Membership |

|Page 2 |

| |

|Agent(s) (Please check the underwriters that apply to you.): |

| |

|AmTrust Title Insurance Co. |

|Chicago Title Insurance Co. |

|Commonwealth Land Title Insurance Co. |

|Fidelity National Title Insurance Co. |

|First American Title Insurance Company |

|Investors Title Insurance Co. |

|North American Title Insurance Company |

|Old Republic National Title Insurance Co. |

|Stewart Title Guaranty Co. |

|Westcor Land Title Insurance Co. |

|WFG National Title Insurance Co. |

| |

| |

| |

|My sponsor’s name and contact information is: |

| |

| |

| |

| |

| |

| |

|I hereby irrevocably waive any claim or right of action at law or in equity that I might have at any time hereafter against MLTA, its officers, |

|directors, committee members or employees, either as a group or as individuals, for any official act in connection with the business of the Association |

|and particularly in: |

| |

|a. admitting or failing to admit me, my firm, or corporation to membership; and |

|b. disciplining me as a member for infraction of the Code of Ethics, Standards or Professional Conduct, Bylaws, or regulations. |

| |

|Signature of Applicant: Date: |

| |

|Printed Name of Applicant: |

| |

| |

|RETURN THIS COMPLETED APPLICATION WITH THE FOLLOWING ITEMS: |

| |

|1. APPROPRIATE DUES FOR THE CURRENT YEAR (see Invoice for Dues) |

|2. COPY OF LICENSE BY STATE OF MICHIGAN |

|3. PLEASE VERIFY THAT SPONSOR NAME IS LISTED ABOVE. |

| |

|MAKE CHECKS PAYABLE TO |

|Michigan Land Title Association and return to: |

|Michigan Land Title Association |

|124 W. Allegan, Suite 1700 – Lansing, MI 48933 |

| |

|Or fax to MLTA: (517) 908-0079 |

-----------------------

MLTA Membership

Dues Invoice

Dues are for July 1, 2019 – June 30, 2020 (1 Year)

Michigan Land Title Association

124 W. Allegan, Suite 1700

Lansing, MI 48933

P: (517) 374-2728 | F: (517) 908-0079

Main Contact: ____________________________ Ph: ______________________

Company: _______________________________ F: _______________________

Address: ________________________________________________________________

City, State, Zip: __________________________________________________________

Email: __________________________________________________________________

Website: ________________________________________________________________

Credit Card – online

Check - Please make checks payable to MLTA and send payment with dues invoice to:

Michigan Land Title Association | 124 W. Allegan, Suite 1700 | Lansing, MI 48933

This MLTA dues billing covers membership from July 1, 2019 to June 30, 2020

MLTA dues are 100 % dedu to June 30, 2020

MLTA dues are 100 % deductible. The MLTA pays the proxy tax for the membership benefit of having 100% dues deductibility.

Agent(s): Please select the underwriters that apply to you:

θ Commonwealth Land Title Ins. Co. θ Chicago Title Ins. Co. θ Fidelity National Title Ins. Co.

θ First American Title Ins. Co. θ Investors Title Ins. Co. θNorth American Title Ins. Co.

θ Old Republic National Title Ins. Co. θ Stewart Title Guaranty Co θWestcor Land Title Ins. Co.

θ WFG National Title Ins. Co. θ AmTrust Title Ins. Co.

Primary County Served: ___________________________________________________________________

Abstractor/Agents & Associates

Gross Revenue for Preceding Year MLTA Dues Gross Revenue from Title Services MLTA Dues

Amount for Preceding Year Amount

θ Under $100,000 $143.00 θ $1,300,001 to $1,600,000 $1,125.00

θ $100,001 to $150,000 $210.00 θ $1,600,001 to $1,900,000 $1,272.00

θ $150,001 to $200,000 $268.00 θ $1,900,001 to $2,200,000 $1,406.00

θ $200,001 to $300,000 $313.00 θ $2,200,001 to $2,500,000 $1,545.00

θ $300,001 to $500,000 $450.00 θ $2,500,001 to $2,800,000 $1,674.00

θ $500,001 to $700,000 $593.00 θ $2,800,001 to $3,400,000 $1,709.00

θ $700,001 to $900,000 $723.00 θ $3,400,001 to $4,000,000 $1,861.00

θ $900,001 to $1,100,000 $847.00 θ $4,000,001 and up $2,084.00

θ $1,100,001 to $1,300,000 $995.00

Underwriters Associate Member

θ $3,859.00 (minimum) θ $300.00

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download