Sales Person Or Contract Broker Registration Application
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3102
Form
(Revised 03/15)
Submit to:
Secretary of State
Registrations Unit
Membership Camping Resort
P.O. Box 13550
Sa les Person or Contract-Broker
Austin, TX 78711-3550
512 475-0775
Registration Application
FAX: 512 475-2815
Filing Fee: $50.00
I am applying for: (please circle one) SALESPERSON
CONTRACT-BROKER
1.
Name of Applicant:
_
_________________________________________________________________
2.
Residence Address:
_________________________________________________________________
____________________________________________________________________________________
3.
Telephone Numbers: Home (
)
__________________
Business (
)
___________________
4.
Business Address:
____________________________________________________________________
____________________________________________________________________________________
5.
Name of Employer: (if applicable)
_____________________________________________________
6.
Address of Employer:(if applicable)
___________________________________________________
_____________________________________________________________________________________
7.
Have you ever been convicted of a felony or a misdemeanor involving moral turpitude?
_________ Yes _________No
8.
If you answered yes to Question 7, describe the nature of the crime, when and where it was committed, and
the disposition of the conviction.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
9.
Have you been refused a real estate broker's or salesperson's license, or any other occupation license in
this or a
________Yes ________ No
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