Ohio Mortgage Bankers Association

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					                                    Ohio Mortgage Bankers Association
                                                                    Application for Membership
                                                                                     January 1 – December 31, 2011
                                                                                    30200 Detroit Road • Cleveland, OH 44145
                                                                             Fax: (440) 892-1404 • Email: omba@ohiomba.org
                                You may also complete an application at ohiomba.org. Have questions? Call us at 440-899-0010


COMPANY                                                              PRINCIPAL REP.                                  EMAIL

STREET & CITY                                                                                STATE                         ZIP CODE

WEB SITE ADDRESS                                                          PHONE                                FAX


TYPE OF BUSINESS: (i.e., Mortgage Banker, Bank, Non-Lender, etc.)

NUMBER OF BRANCHES : *Fax and email are used for member communication.

DATE ORGANIZED                                             Corporation            Partnership            Proprietorship


Does applicant own or control, is owned or controlled by, or is a subsidiary or affiliate of any other mortgage company, financial
institution, construction (home building), or any other group?     Yes       No (If Yes, fully explain by letter)

Have any officers of the applicant been involved in bankruptcy, insolvency, made assignment for benefits of creditors, or been indicted
for or charged with fraud or misrepresentation?      Yes      No (If Yes, fully explain by letter)

Approved FHA Mortgage:        Yes       No             Has the FHA or VA ever suspended you?                  Yes        No
                                                                                                          (If yes, fully explain by letter)


COMPANY                                                REPRESENTATIVE                                PHONE

COMPANY                                                REPRESENTATIVE                                PHONE

Additional company contacts to receive OMBA Alerts (or attach separate sheet of names with email addresses) :

         Name:                                                            Email address:
Company’s volume of loans originated in Ohio the previous year       RESIDENTIAL $
                                                                      COMMERCIAL $
Company’s volume of Ohio loans serviced the previous year            RESIDENTIAL $
                                                                      COMMERCIAL $

Category 1 –   Mortgage Bankers: Ohio-based companies that originate, purchase, service, or sell loans (residential and/or
               commercial). Dues are calculated on the greater of either the Origination Volume or Servicing Volume.
Category 2 –   Corporate Sustaining Member: This category includes: Dues for 1 designated individual, education sponsorship, and
               golf hole sponsorship, Bronze Sponsorship and Exhibitor Booth at Annual Convention.
Category 3 –   Non-Lender Companies: Companies that either support, or are engaged in the mortgage industry other than in loan
               origination and/or servicing of loans.
               3A – For Profit
               3B – Not for Profit
Category 4 –   Non-Ohio Based Lender/Broker: Lenders or Brokers not headquartered in Ohio.
Category 5 –   Affiliated Organizations: Companies legally affiliated with another OMBA member company, regardless of company
Category 6 –   Individual Supporter: (Non-Member)

                                                                               Eligible                   CONV
                                                                   Eligible                 CONV                     CONV
                                               Annual                             for
                                                            Vote      for                               Golf Hole
                                                Fee                             Exec.      Sponsor                   Booth
                                                                   Board                                Sponsor

                 1A     $2 Billion +           $2,550        X        X           X            X            X           X

                        $1 Billion –
                 1B                            $1,875        X        X           X            X            X
                        $1.999 Billion
                        $500 Million –
                 1C                            $1,400        X        X           X            X            X
                        $999 Million
                        $300 Million –
                 1D                            $1,225        X        X           X
                        $499 Million
                        $150 Million –
                 1E                            $1,100        X        X           X
                        $299 Million
                        $50 Million –
                 1F                            $875          X        X           X
                        $149 Million

                 1G     < $50 Million          $550          X        X           X

                 2                             $3000         X        X           X         Bronze          X           X
                        Sustaining Member
                        Non Lender
                 3A                            $700          X        X
                        for Profit
                        Non Lender
                 3B                            $650
                        Not for Profit
                        Non OH Based
                 4                             $500
                 5                             $225
                 6      Individual Supporter   $150

   Check (enclosed for full amount made payable to the OMBA)                   VISA            MasterCard            American Express              Discover

Account Number:                                                                                          Expiration Date:

Security Code (3 – 4 digit code on back of card):                      Authorized Signature:

Billing Address:                                                                                         Membership Dues: $

Payment of dues or other contributions to           The Ohio Mortgage Bankers Association (OMBA) collects credit card information to make it easier for you
the Association are not tax deductible as           to register for seminars and events online, as well as paying for other services. OMBA does not use or
charitable contributions for income tax             share credit card information for any other purpose. We retain such information as is needed for standard
                                                    accounting record keeping requirements. Every step is taken to protect the loss, misuse, and alteration of
purposes. They may, however, be deductible          the information under our control. If you are uncomfortable or wary, please use a check or money order to
as a business expense.                              make any necessary payments. Thank you.

Member Company                                               Designated Representative                                       Date

                              For questions regarding membership contact the OMBA Executive Office:
                              Phone: (440) 899-0010 • Fax: (440) 892-1404 • Email: omba@ohiomba.org
Completed application forms with payment should be remitted to: OMBA, 30200 Detroit Road, Cleveland, OH 44145-1967
Dec 2010