Sd Eform - 2160 V1 - Application For Registration - Appraisal Management Company
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Complete and use the button at the end to print for mailing.
SD EForm - 2160
V1
HELP
STATE OF SOUTH DAKOTA
APPLICATION FOR REGISTRATION – APPRAISAL MANAGEMENT COMPANY
INSTRUCTIONS: (Please type or print.)
DO NOT WRITE IN THIS SPACE
1. Complete the information requested below and obtain
Date application rec’d______________________________
notarization(s).
Date application approved__________________________
2. Attach a check or money order in the amount of $1,000,
Registration Number_______________________________
made payable to the Appraiser Certification Program.
Date issued______________________________________
NOTE: All fees are non-refundable.
COMPLETION OF APPLICATION FORM
All questions on this application must be answered fully and completely as required. The applicant Entity's Designated Officer
must complete the Uniform Irrevocable Consent to Service of Process at Section G and the Declarations at Section H.
SECTION A: APPRAISAL MANAGEMENT COMPANY (ENTITY)
1. LEGAL NAME
2. FEI NUMBER
3. ALL OTHER TRADE OR BUSINESS NAMES
4. BUSINESS
Street
City
State
ZIP Code
5. BUSINESS
(If different from the
address in Item 4 above)
Address
City
State
ZIP Code
8. WEBSITE
6. BUSINESS TELEPHONE NUMBER
7. BUSINESS FAX
(Any change of information must be reported within five days.)
SECTION B: DESIGNATED OFFICER
1. NAME
2. TITLE
Last
First
Middle
Suffix
3. MAILING ADDRESS
Address
City
State
ZIP Code
4. BUSINESS TELEPHONE NUMBER
5. BUSINESS FAX
6. PHYSICAL RESIDENCE ADDRESS (If different from the mailing address in Item 3 above)
Address
City
State
ZIP Code
7. EMAIL ADDRESS
(Any change of designated officer must be reported within five days.)
Page 1 of 4
AMC APPLICATION (08/11)
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