GMLA Membership Application

Membership Application
Today's Date *

Month Day Year
New or Renewal Membership *
Primary Member Name: *

First Name Last Name
Office Phone Number: *

Area Code Phone Number
Cell Phone Number: *

Area Code Phone Number
Primary Member E-mail: *
Company Name: *
Street Address & Suite Number: *
City: *
State: *
Zip: *
Membership Application Details
Please check all that apply to your company: *

Mortgage Broker Retail Only Lender Wholesale & Retail Lender Wholesale Only Lender Correspondent Lender Primarily Servicing
Mortgage Products Offered (check all that apply): *

Conventional Conforming Conventional Jumbo FHA Loans VA Loans FHA Reverse Non-QM Loans Commercial Loans Hard Money Loans Private Investor Loans Not Applicable
Please check states in which you conduct business: *

ALL 50 AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Company Operations Data (check all that apply): *

In House Loan Processors Outsourced Loan Processing In House Quality Control Outsourced Quality Control In House Compliance Personnel Outsourced Compliance Services In House Loan Underwriting Outsourced Loan Underwriting Not Applicable
Please check item(s) that best describe your services: *

Mortgage Company Accounting Services Appraisal Management Co. Continuing Education Services Credit Services Document Services Insurance Services Legal Services/Attorney Sales Training Services Technology/Software Services Title Services

Select Membership: *

Mortgage Broker $ 275.00

Mortgage Banker $ 550.00

Affiliate Membership (Non Mortgage Entity) $ 400.00

Individual Account Representative $ 300.00

Payment Method

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Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please check below to indicate your acceptance of the following GMLA membership requirements: *

I/We agree to the GMLA Code of Ethics I/We agree to accept emails from the GMLA
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Membership Application

Membership Application Details