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2023.2024 Membership Form for NON MEMBERS
Applicant Information
First Name
*
Last Name
*
Business Name
*
Business Address
*
City
*
County
*
State
*
Zip
*
Telephone
*
Fax
Email
*
Website
Applicant is:
*
Incorporated
Sole Proprietor
Partnership
If incorporated, date of incorporation
If incorporated, state of incorporation
Active Officers, Proprietors or Partners (names and titles)
Owner's Name
*
Applicant is applying for membership as: (See Bylaws, Article III)
*
Abstractor/Agent/Associate
Associate Member
Underwriter
PLEASE CALL MLTA OFFICE FOR MEMBERSHIP DUES AMOUNT
Primary County served
Other Counties served
Agents, please select the underwriters that apply to you
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.
Title Resources Guaranty Company
Westcor Land Title Insurance Co.
WFG National Title Insurance Co.
My sponsor's name and contact info is:
*
Waiver
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
*
Name of applicant
*
Copy of License by State of Michigan
Accepted file types: jpg, gif, png, pdf, jpeg, doc, docx, Max. file size: 32 MB.
Payment
If you are applying as an Underwriter, please call the MLTA office for membership dues amount before sending payment to: Michigan Land Title Association, 124 W. Allegan, Suite 1700, Lansing, MI 48933
Abstractor / Agents & Associates
Under $100,000 ($143)
$100,001 to $150,000 ($210)
$150,001 to $200,000 ($268)
$200,001 to $300,000 ($313)
$300,001 to $500,000 ($450)
$500,001 to $700,000 ($593)
$700,001 to $900,000 ($723)
$900,001 to $1,100,000 ($847)
$1,100,001 to $1,300,000 ($995)
$1,300,001 to $1,600,000 ($1,125)
$1,600,001 to $1,900,000 ($1,272)
$1,900,001 to $2,200,000 ($1,406)
$2,200,001 to $2,500,000 ($1,545)
$2,500,001 to $2,800,000 ($1,674)
$2,800,001 to $3,400,000 ($1,709)
$3,400,001 to $4,000,000 ($1,861)
$4,000,001 and up ($2,084)
Gross Revenue from Title Services for Preceding Year
1
Associate Member
Price:
1
Payment Options
*
Credit Card
Check (make to: Michigan Land Title Association, 124 W. Allegan, Suite 1700, Lansing, MI 48933)
Credit Card
American Express
MasterCard
Visa
Supported Credit Cards: American Express, MasterCard, Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
Expiration Date
Security Code
Cardholder Name
Total
$0.00
Comments
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