Application for New Brokerage/Appraisal Firm

Office Name *

Office Street Address *

Office City *

Office State *

Email Address

Office ZIP Code *

Are your physical and mailing addresses the same? *

Yes

No

Office Mailing Address

Office Mailing City

Office Mailing State

Office Mailing ZIP Code

Office Phone *

Name of Principal Broker *

Principal Broker eMail Address *

Name of Designated REALTOR® *

The Designated REALTOR® must be a sole proprietor, partner, corporate officer, or branch office manager acting on behalf of the firm’s principal(s) and must meet all other qualification for REALTOR® membership. The Designated REALTOR® shall be responsible for all duties and obligations including the payment of fees.

Designated REALTOR® eMail Address *

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