| Name as shown on License:_________________________________________ |
Nickname: ______________________ |
| Address:________________________________________________________ |
Home Phone: ___________________ |
| City:
________________________________ St. _____ Zip: ___________ |
County: _______________________ |
| Virginia Auctioneers
License No.: _________________ Date of Birth: ____________ Spouses Name:
_______________ |
| Member of: NAA
____Yes ____No Designations (please circle): CAI, AARE. GPPA
Other: ____________-__________ |
| Name of Firm:
_____________________________________________________ |
Office Phone: __________________ |
| Firm Address:
_____________________________________________________ |
Fax No.: ______________________ |
| City:
_____________________________________ St. _____ Zip: ___________ |
E-Mail: ________________________ |
| Check Whether: ____Individual
_____DBA _____Partnership _____Corporation |
Web Site: _____________________ |
The following legal resident of Virginia may be referred to for a character reference.Name:_____________________________ Address:
_______________________________ Phone: ________________ |
| PERSONAL BUSINESS DATA |
1. Auctioneer
for how many years? _____ 2. Auction School Attended
_____________________________________
3. Type(s) of auctions you conduct
_______________________________________________________________
4. Are you a real estate ____ Broker ____Salesperson 5.
Are you a Member of the Board of Realtors ____Yes ____No
6. Name of real estate firm licensed with ( if other than own)
___________________________________________
7. Have you ever been refused membership in this association or any other
Auctioneers Association? ___Yes ____No
If yes, specify_______________________________________________________________
8. Do you hold, or have you ever held, an auctioneers license in any other state?
_____ Yes _____No
If yes,
specify________________________________________________________________________________
9. Has your auctioneers license, in this or any other state, been suspended or
revoked? _____Yes _____No
If yes, specify the place(s) and date(s) of such action, and detail the circumstances
relating thereto*
_______________________________________________________________________________
10. Are there now, or have there been within the past 5 years, any complaints
against you or the firm with which you have been associated before any state Auctioneers
Regulatory Agency or any other agency of government? _____Yes
_____No If yes give details* ________________________________________________________________________
11. Have you ever been convicted of a felony? ____Yes ____No
If yes give details*
_________________________________________________________________________________ |
I hereby certify that the foregoing information furnished by me is true and correct, and I
agree that failure to provide complete and accurate information as requested or any
misstatements of fact, shall be grounds for revocation of my membership if granted. |
Applicant's
signature : _______________________________________________________
|
Recommended by current VAA
Member: ________________________________
Members Name (Signature Required) |
___________________________________________________________
Address
Phone |
|
*Attach separate sheet(s) as required |
|