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PARTICIPANT/SUBSCRIBER APPLICATION FORM

APPLICANT INFORMATION

BRE/APPRAISER LICENSE NO*: LICENSE EXP. DATE*:

LICENSEE LEGAL NAME :

Prefix
First*
Middle
Last*
Suffix

LISTING/INTERNET NAME :

First
Middle
Last

Public name for display on Listings or Internet


APPLYING AS (Select One)*:


LICENSE TYPE (Select One)*:


CONTACT INFORMATION :

Private email*

For MLS correspondence
Public email*

For display on Listings or Internet
Agent's Web Address:
Listing/Internet Phone

Public phone number for display on Listings or Internet
Home Phone:
Cell Phone:
 
Fax Number:
Work Phone*:
EXT:

PREFERRED PHONE FOR MESSAGES FROM MLS (Select One)*:


HOME ADDRESS :

Street
City
State
Zip Code

BILLING ADDRESS :

Street
City
State
Zip Code

SECURITY QUESTION*: City of Birth


REFERRING ASSOCIATION/SERVICE CENTER

Select one *:


OFFICE INFORMATION

OFFICE NAME*:
BROKER CODE:
BROKER’S NAME :
BROKER’S BRE #*:

FIND BROKER BRE#

PHYSICAL ADDRESS:

Street*
City*
State*
Zip Code*
County*

MAILING ADDRESS:

Street (PO Box)
City
State
Zip Code
OFFICE PHONE*:
OFFICE FAX:
CORPORATION NAME:
CORP. WEB ADDRESS:

MLS INITIATION FEE (SELECT ONE SUBSCRIPTION TYPE)*:

 PARTICIPANT (BROKER) - $300 SUBSCRIBER (AGENT) - $200

MLS ACCESS FEES (SELECT ONE PAYMENT PERIOD)*:

 ANNUAL ($54 X 12 MONTHS) - $648 SEMI-ANNUAL ($60 X 6 MONTHS) - $360 QUARTERLY ($66 X 3 MONTHS) - $198

(PAYMENT INSTRUCTIONS WILL FOLLOW BY EMAIL)


SIGNATURES


I certify that the information given on this application is true and correct. I Agree*

I understand that by becoming and remaining a Participant or Subscriber to the MLS I am subject to the MLS Rules and Regulations as they are from time to time amended. I Agree*

I understand that persons other than principals, partners or corporate officers of real estate or appraisal firms must remain employed by or affiliated with a Participant to remain an MLS Subscriber. I Agree*


Do not sign the application at this time. You will be notified by email when this form is submitted to DocuSign for electronic signature. After your signature is received, your membership will be processed within 48 hours. If you are applying as an Agent, your broker will be notified once your membership is complete.

 

AGENT SUBSCRIBER ACCEPTANCE: ____________________________________________ DATE: ______________________________

BROKER PARTICIPANT ACCEPTANCE: ____________________________________________ DATE: ______________________________

(IF OFFICE MANAGER IS SIGNING ON BROKER’S BEHALF, ENTER MANAGER’S NAME) ____________________________________________

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