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Designated Broker Application

Application must be accompanied by a check in the amount of five hundred dollars ($500), made payable to Multilist Service of Springfield REALTORS®, Inc., for the application fee. If for any reason your application is denied your application fee will be refunded.

Office Information

Office Name:

Branch:

Office Address:

Office Phone:

Office Fax:

Office NRDS#:

Office License #:

Primary Board of REALTORS®:

Personal Information

Name (As it appears on license):

Nickname:

Date of Birth:

Full Address:

Cell Phone:

Home Phone:

E-Mail Address:

Website:

Are you fluent in any language other than English?

Yes

Individual License/Work Permit #:

I hereby agree as a condition of participation in the Multilist Service of Springfield REALTORS®, Inc., to abide by the Bylaws, Rules and Regulations of the Service, and other obligations of participation including payment of fees. I further agree to be bound by the NATIONAL ASSOCIATION OF REALTORS® Code of Ethics including the obligation to submit to ethics hearings and the duty to arbitrate contractual disputes with other REALTORS® in accordance with the established procedures of the Board/Association. I understand that a violation of the Code of Ethics may result in termination of my MLS privileges and that I may be assessed an administrative processing fee of up to two hundred fifty ($250), which may be in addition to any discipline, including fines, that may be imposed.

I irrevocably waive all claims against the Multilist Service or any of its officers, directors, staff, or members for any act in connection with business of the Multilist Service and particularly as to it’s or their acts in electing or failure to elect, advancing, suspending, expelling, or otherwise disciplining me as an applicant or as a member.

Date:

NOTE: Application Fees and Dues are Non-Refundable and Non-Transferrable. Application must be received within 30 days of License Issue Date

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Timestamp

Audit

August 17, 2020 7:34 am CDT

Designated Broker Application Uploaded by Membership GSBOR - [email protected] IP 76.77.137.154

August 17, 2020 8:32 am CDT

Membership Team - [email protected] added by Membership GSBOR - [email protected] as a CC'd Recipient Ip: 76.77.137.154

August 17, 2020 8:32 am CDT

Membership Team - [email protected] added by Membership GSBOR - [email protected] as a CC'd Recipient Ip: 76.77.137.154

December 31, 2020 2:57 pm CDT

Membership Team - [email protected] added by Membership GSBOR - [email protected] as a CC'd Recipient Ip: 76.77.137.154

December 31, 2020 2:57 pm CDT

Membership Team - [email protected] added by Membership GSBOR - [email protected] as a CC'd Recipient Ip: 76.77.137.154