Appraisal Management Company Registration Application Page 2
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10D. List the names and contact information for any individual that owns, is an officer of, or has a greater than 10%
financial interest in the AMC. You may attach additional pages if necessary. Please mail a completed, signed and
notarized Authorization for Release of Information form for each individual with a fee in the amount of $15.00 made
payable to the New Mexico Department of Public Safety for state criminal history background check.
Name:
Title or Position:
Street Address:
City:
State:
Zip:
Address of Business:
Business Phone:
Fax:
(Required)E-Mail:
Name:
Title or Position:
Street Address:
City:
State:
Zip:
Address of Business:
Business Phone:
Fax:
(Required)E-Mail:
Name:
Title or Position:
Street Address:
City:
State:
Zip:
Address of Business:
Business Phone:
Fax:
(Required)E-Mail:
Name:
Title or Position:
Street Address:
City:
State:
Zip:
Address of Business:
Business Phone:
Fax:
(Required)E-Mail:
Name:
Title or Position:
Street Address:
City:
State:
Zip:
Address of Business:
Business Phone:
Fax:
(Required)E-Mail:
Name:
Title or Position:
Street Address:
City:
State:
Zip:
Address of Business:
Business Phone:
Fax:
(Required)E-Mail:
Appraisal Management Company Registration Application
(Rev. 07/2015)
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