Agent's Name
*
First Name
Last Name
Email
*
Phone Number
*
(###)
###
####
Birthday
MM
DD
YYYY
License Number
*
License Expiration Date
*
Brokerage License Number
*
Broker's Expiration Date
*
MM
DD
YYYY
Licensed Supervisor, Broker, or Compliance Manager
*
Who is your go to contact at your brokerage for questions regarding forms, payments, etc.?
First Name
Last Name
Email for your Licensed Supervisor, Broker, or Compliance Manager
*
Phone Number for your Licensed Supervisor, Broker, or Compliance Manager
*
(###)
###
####
Is the above contact who we should send commission instructions to for signing?
If no, please provide their contact below.
Additional Contact Info for Commission Instructions Signee - If applicable
Office Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Login & Password to MLS
*
Login & Password to Compliance Management Software
*
Any other logins if applicable, or notes about any of the above login info
Does your broker require specific forms for compliance outside of GLVAR forms?
*
For example, an affiliated business disclosure, SRPD addendum, DO supplemental. If yes, please attach in the file upload button below so we may save for our file
Brokerage Fee Structure
*
Please provide details regarding your broker's payment structure such as splits, transaction fees, etc.
Preferred Escrow/Title Company
Officer's Name
First Name
Last Name
Officer's Email
Officer's Phone Number
(###)
###
####
Preferred Lender
Lender's Name
First Name
Last Name
Lender's Email
Lender's Phone Number
(###)
###
####
Preferred Inspection Company
Inspector's Name
First Name
Last Name
Inspector's Email
Inspector's Phone Number
(###)
###
####
Additional contact information
Additional information
Thank you for your submission!
Reign TC is reviewing and will let you know if there’s anything else needed.
