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Membership Application:

Business Information

Firm name:

Number of Offices Nationally:

Corporate Headquarters city/state

Please indicate the activities in which your organization is currently involved:
Residential Origination
Servicing
Construction Lending
Commercial Lending


other Is your firm a subsidiary of another company?: YES NO

If your firm is a subsidiary of another company, please complete the following:

Parent Company Name:

Parent Company Address:

Parent Company City/State/Zip:



Mailing Address:

City/State/Zip:

10 Digit Phone:

10 Digit Fax:

Email:

Web Address:

Type of Business:

Referred by:


Representative Information


Name Of Authorized Representative:

Representative's Title:


Type of membership:
FULL $450
ASSOCIATE $350
Individual $250


All applicants must certify that they subscribe to the NMMLA Code of Ethics (clicking on this link will not disrupt the application process)

Completing this section is also your formal request to be considered for membership in NMMLA. By completing the section below, you agree that the information contained in this application is true to the best of your knowledge and give permission to NMMLA to contact the References listed above.

On behalf of the company named above, I hereby certify that we have conducted our business according to the NMMLA Code of Ethics contained on this site and in accordance with the applicable standards of any other business or profession in which we have been engaged. We hereby pledge to observe and maintain these standards.

Birth City and Month are provided on this electronic form in lieu of a traditional signature

Name Of Authorized Representative:
Representative's Title:
Representative's Birth City:
Representative's Birth Month:
Representative's NMLS Number: