Membership Application - Mortgage Bankers Assocation of Maine

Maine Association of Mortgage Professionals Dues

Affiliation

Individual Member
Lender Member
Affiliate Member
Wholesale Rep

Contact Information

Company Name:
Number of Employees in Maine:
Applicant Name:
Business Type:
Address:
City:
State:
Zip Code:
Phone:
Fax:
E-mail Address:

Additional individuals to receive MBA communications:

Name: Email:
Name: Email:
Name: Email:
Name: Email:
Name: Email:

Managing Officers (NOTE: Your company must have been in business for 6 months before your application can be considered.)

Name: Position:
How Long Active Percent of Ownership in THIS Company:
Name: Position:
How Long Active Percent of Ownership in THIS Company:

Have any of your officers or the applicant ever been involved in bankruptcy, insolvency, made assignment for creditors, or been indicted for, or charged publicly with fraud or misrepresentation?

Yes No

If yes, please explain:

Please provide a summary of employment activities for the named applicant for the last 5 years:

Do you regularly provide services or other products for organizations that originate, service or invest in mortgage loans or other types of real estate finance? (May include, but is not limited to legal, accounting, title insurance, private mortgage insurance, appraisal, data processing, or other services directly related to the mortgage banking industry.)

Yes No

Type of service or products provided:

REFERENCES: Please attach brief written references from two current MBA of Maine members. Your application will not be complete until these are received. (See members for a list of members.)

Reference 1:
Reference 2:

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