Affiliate Member Application

The undersigned hereby applies for Membership in the Mortgage Bankers Association of Southwestern Pennsylvania. The non-refundable application fee of $50.00 is included with your application.

The Applicant authorizes the Mortgage Bankers Association of Southwestern Pennsylvania and its Membership Committee to invite and receive information and comment about the Applicant from any member or other person, and further agrees that any information or comment furnished to the Association by any person in response to the invitation shall be conclusively deemed to be privileged and shall not form the basis of any action by the Applicant for slander, libel or defamation of character.

Applicant Organization

Applicant Representative

Have you ever been denied FHA/VA/FNMA/GNMA/FHLMC approval or has your approval ever been suspended or terminated or have any of your Officers or the Applicant ever been involved in bankruptcy, insolvency, made assignment for benefit of creditors, or been indicted for or charged publicly with fraud or misrepresentation?


The applicant certifies that he/she is duly licensed by the Commonwealth of Pennsylvania pursuant to the provisions of the Mortgage Licensing Act, 7 Pa. C.S. § 6101 et seq. and its subsequent amendments. In the event Applicant becomes a member of the Mortgage Bankers Association of Southwestern Pennsylvania (“Association”), Applicant covenants to promptly notify the Association, in writing within 30 days, if said applicant’s license issued pursuant to the provisions of aforesaid Act should be, either voluntarily or involuntarily, suspended, revoked or refused to be renewed.

Application Sponsor

Those applicants who are currently members of another Mortgage Bankers Association have the option of submitting a reference letter from their organization as a substitute for the letter of recommendation.