b'Membership ApplicationName: ______________________________________________________________________________________Company:___________________________________________________________________________________Address: ____________________________________________________________________________________City: ___________________________________________________State: _______Zip +4:_____________Day Phone: __________________Mobile Phone:___________________Fax: _____________________E-Mail: ______________________________________________________________________________________Power ofAnnual Gross Closings:$ _______________ Referred by: ______________________________________PLEASE LIST ALL LICENSES HELD:Membership License No.Regulator/Issuer (i.e., DRE, NMLS, etc.)MISSION STATEMENT ___________________________________________________________________________________________The California___________________________________________________________________________________________Mortgage Association___________________________________________________________________________________________is committed to___________________________________________________________________________________________providing legislative advocacy, legalHas your license or that of an affiliated company ever been suspended or revoked or have resources andthere been any complaints within the last ten years?If yes, please provide details:education programs for our members_____________________________________________________________________________________________to enhance their_____________________________________________________________________________________________professionalism.We believe that the public good is servedTell us about your professional work history:when professionals_____________________________________________________________________________________________serve the public._____________________________________________________________________________________________Regular Member _____________________________________________________________________________________________Any reputable individual, sole proprietorship,Tell us about your current company history and business focus, branches, employees, and corporation, limitedother pertinent details:liability company, or_____________________________________________________________________________________________partnership primarily_____________________________________________________________________________________________engaged in the_____________________________________________________________________________________________Mortgage Business in the state of California.How did you become aware of CMA?Affiliate Member _____________________________________________________________________________________________Any reputable individual,_____________________________________________________________________________________________sole proprietorship, corporation, limited liability companyDo you know other CMA members?If yes, who?or partnership who_____________________________________________________________________________________________regularly provides services or products to_____________________________________________________________________________________________persons engaged in the Mortgage Business. PROFESSIONAL REFERENCESEducational Member Name __________________________________________ License Number (if a licensee) _________________Any reputable individual,Firm Name_________________________________________________________________________________sole proprietorship,Relationship ________________________________________________________________________________corporation, limitedPhone ________________________________ E-mail_____________________________________________liability company orName __________________________________________ License Number (if a licensee) _________________partnership engaged inFirm Name_________________________________________________________________________________the Mortgage BusinessRelationship ________________________________________________________________________________who is not subject to thePhone ________________________________ E-mail_____________________________________________provisions of Business & Professions Code Name __________________________________________ License Number (if a licensee) _________________(revised 8/11/16)10232(a)-(b) ("thresholdFirm Name_________________________________________________________________________________broker"), or under anyRelationship ________________________________________________________________________________successor statute. Phone ________________________________ E-mail_____________________________________________Spring 2021 Page 31'