WP E-Signature by Approve Me - Sign Documents Using WordPress -

General

Name (As it appears on license):

Nickname:

Date of Birth:

Full Address:

Cell Phone:

Home Phone:

E-Mail Address:

Website:

Classification:

REALTOR® ($45)

Appraiser ($45)

Unlicensed Assistant ($25)

Will you primarily be working with an agent or team within the office that holds your license?

Yes

No

If yes, provide the name of agent you will be assisting:

Primary Board of REALTORS®:

Office Information

Office Name:

Branch:

Office Address:

Office Phone:

Office Fax:

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 a misstatement of fact, may be grounds for revocation of my membership, if granted. I agree that, if accepted for membership in the Association, I shall pay the fees and dues as from time to time established.

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