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ONLINE APPLICATION FOR ACTIVE MEMBERSHIP

(Use your [Tab] and "Shift"[Tab] keys to move between fields.
Click the "Submit Application" button below, or press the "Enter" key
on your keyboard to send your Application to the Executive Director.)

User Name:		User Email:
Name of Company applying:
Street Address:
Mailing Address:
City, State, Zip Code:
County:
Phone No.:		Fax No.:
Email:		Web Address:
Is applicant a Title Insurance Underwriter?	Yes: No:	If yes, please send a copy of your Certificate of Authority to NMLTA at the above address.
If successor to some other company, please give names and date of the parent company:
Are you now engaged in compiling abstracts of title?	Yes: No:	What county(ies)?
Are you engaged in the writing of title insurance?	Yes: No:	What county(ies)?
Does your plant presently comply with the laws presently in effect in the state of New Mexico?		Yes: No:
Has the Department of Insurance approved your plant?	Yes: No:	If so, when?
List all title insurance underwriters whom you represent as an agent:
Who is responsible for recruiting your application for membership to the Association?
The official contact person for the company is:
List all officers and titles:
Please send copies of all personnel's current title guaranty licenses to NMLTA at the above address.
IT IS UNDERSTOOD AND AGREED BETWEEN THE APPLICANT AND THE ASSOCIATION THAT:
The information in this application is to be held in confidence by the Association and used only for the purpose of passing on the qualification for membership of the applicant. Applicant certifies to the Association that the information contained herein is true to the best of his/her knowledge and belief. Applicant agrees, in the event of approval of this application to abide by the By-laws and the Code of Ethics of the Association then and subsequently in effect.

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Form Last Updated: September 18, 2005

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