Broker Registration Form
Company Information:
Company Name
Your Name: .
Address
City
State..
Zip Code
Business Phone:
Business Fax:
Business Email:
Broker of Record:
Broker Phone:
Banking Information:
Bank is authorized and directed to mail all banking information on this account including but not limited to our monthly bank statements, canceled checks, analysis and returned items.
Mail attention to:
Gateway Title
Virtual Escrow Technology Department
9454 Wilshire Blvd., Suite 710
Beverly Hills, California 90212
List Authorized Signers:
Name	Name	Name
List of Personnel to be trained on software:
Name:	Name:	Name:
Name:	Name:	Name:
Name:	Name:	Name:
Enter Your Title Representative:
Are you currently using Virtual Escrow? Yes No	If yes, what Trust Account Bank are you currently using?	If yes, do you require additional training? Yes, No
The Virtual Escrow system contains proprietary data licensed from Lane Guide. The license agreement with Lane Guide requires that each subscribing broker office (physical address) be a licensed user of Lane Guide. At the time of application your information will be forwarded to Lane Guide. After you have closed your first escrow using Virtual Escrow Technology, your broker code will be submitted as an active broker and you will receive a Lane Guide CD-ROM. directly from Lane Guide. This CD-ROM contains all lender data nationwide, including wholesale lender search capabilities. We recommend you install this CD as a reference to locate additional lenders not found in the Virtual Escrow system. Please be advised that subsequent annual renewals will be billed to you directly from Lane Guide. Failure to maintain your Lane Guide subscription (license) may result in discontinuance or limited access to the Virtual Escrow software or systems. If you are already a current (paid) Lane Guide subscriber, please indicate yourSubscriber No. Here: