Form 370-5 - Solicitor'S Permit Application
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1
2SolIcItor’S PermIt APPlIcAtIoN
Form
370-5
Note: Read instructions carefully. Incomplete or incorrect applications will be returned.
Permit Year
______________
New Permit
Renewal
Transfer
Duplicate
If renewal, transfer or duplicate give present permit number SP __________________
Office Use Only
Name
Number _______________
Permit Year _____________
Home address
Stub Number ___________
City
State
9 Digit Zip code
Approved ______________
Date __________________
Date of birth
Social Security Number
Phone number
Check Number __________
Check Amount $ ________
E-mail address
Deposit Date____________
List the company(ies) you represent in the state of Maryland below. If you represent more than one company, list the principal one
first. The license or permit number should be the number the state of Maryland has assigned to that company. The company’s name
and address should be identical to the information appearing on its Maryland license or permit. Be complete and accurate. If additional
space is required attach a separate sheet.
Maryland
Company telephone
license or
Company name
Company address
number
permit number
1.
2.
3.
4.
Note: Independent brokers must submit
a letter from the Maryland license or
Office use only
permit holder they represent verifying
that their company is authorized to do so.
COM/RAD-370-5
12-49
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Parent category: Financial