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SECRETARY OF STATE MEMBERSHIP CAMPING RESORT SALES PERSON or CONTRACT-BROKER
REGISTRATION APPLICATION
I am applying for: (please circle one) SALESPERSON 1. 2. CONTRACT-BROKER

Name of Applicant:__________________________________________________________________ Residence Address:_________________________________________________________________ ____________________________________________________________________________________

3. 4.

Telephone Numbers: Home (

)__________________ Business (

)___________________

Business Address:____________________________________________________________________ ____________________________________________________________________________________

5. 6.

Name of Employer: (if applicable)_____________________________________________________ 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 any other state? ________Yes ________ No

10.

If you answered yes to Question 9, explain fully the circumstances of the refusal. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Form #3102

11.

Has your license as a real estate broker or salesperson in this or any other state ever been revoked or suspended? _______ Yes ________ No

12.

If you answered yes to Question 11, explain fully the circumstances of the denial or suspension. ____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

I certify (or declare), under penalty of perjury, that I have read the foregoing registration and that all the answers are true and correct. Further, I understand and agree that any misstatements of a material fact in this application may result in suspension or revocation of my registration with the State of Texas.

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____________________________________________ Signature of Applicant

************************************************************ RETURN THIS APPLICATION WITH THE $50.00 FILING FEE TO: SECRETARY OF STATE
STATUTORY DOCUMENTS SECTION
P. O. BOX 13550
AUSTIN, TX 78711-3550


Form #3102