1. Name*

2. Address*

3. Telephone*

4. Fax

5. E-mail

6. Web site

7. My company is a:
Corporation  Partnership/LLC   Individually-owned

8. Number of years in business:
Less than 1 year  1-5 years  5+years

9. Are you a mortgage banker? Yes  No

10. Are you a mortgage broker?  Yes  No

11. Are you an affiliate Yes  No

12. What is your New Hampshire Mortgage Banker/Mortgage Broker license number?

(You will be required to send us a copy of your license and personal work resume, before your application is approved).

13. Have you ever been denied approval of any of the above or has your approval ever been suspended or terminated by Fannie Mae, Freddie Mac, FHA, or any other state and/or federal agency or correspondent lender?

Yes No (If yes, explain by letter)

14. Name of manager/principal

15. Position in company

16. How long active:
In company   In industry   Number of employees

17. Please provide two references who are MBBA-NH regular /affiliate members:

18. In order to ensure that all mailings to you from our association arrive on a timely basis, please provide the following information if different from applicant (Name of primary contact, title, mailing address, phone, fax, and e-mail).

19. Please list any additional contacts, areas of responsibility, as well as phone, fax, and e-mail address.

20.Would you like to serve on or suggest anyone for our committees?

Committee membership
(Education, Ethics, Legislative, Membership, Programs, Other)

21. The individual listed below hereby applies for membership in the Mortgage Bankers and Brokers Association of New Hampshire, Inc. (MBBA-NH), and affirms that the applicant is in accord with and conducts its business in conformity with the purposes of the MBBA-NH Canons of Ethics and Standards of Practice.

Application for: Regular  Affiliate  Broker  Membership

Name of applicant:

Today's Date:

To process your membership application and proceed to part two of the application process, please click the submit button below.