Emerging Member Enrollment

Organizations that are MSB’s but operate under another’s license (e.g. Agent), or their time spent in the marketplace is less than 12 months or they have an International presence only.

Company Contacts

Primary Contact

First Name

Last Name

Phone

Title

Secondary Contact

First Name

Last Name

Phone

Title

Principal Office Address

Address

City

State

Zip Code

References

Please list 2 client references that can attest to your involvement support MSB’s. (We will not contact them before informing you.)

Reference 1

Company Name

Contact Full Name

Reference 2

Company Name

Contact Full Name

Approval

The above named company hereby registers as an Associate Member of the Money Services Business Association (MSBA). We agree to participate in MSBA activities, comply with MSBA rules, and support the goals of the MSBA, in accordance with applicable laws.

I accept the terms above and testify to the accuracy of the information provided above.

Full Name

Serves as a digital signature.

An invoice with payment instructions will be sent after review of enrollment form.