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Everything on this Form is Required
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Brokerage Name
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eg. Remax,
Llewellyn, Miller, Coldwell
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Brokerage Phone
Number
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please
enter only numbers
No dashes, No
periods, No parentheses
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Agent Name
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optional
if Broker Account, agents: NAME ONLY
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Agent Phone Number
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If
Broker account, re-enter phone.
NUMBERS ONLY!
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Agent Cell phone
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improves
turnaround time
NUMBERS ONLY!
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MRIS License number
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this will
be your account number
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Agent Email
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if you
want confirming emails, make sure this field is filled in accurately
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Billing Info
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Card Number
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NO DASHES !
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Card Type
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Expiration Date
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Month Year
20
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2 digit date (09, 10)
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Holder's Name
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The name
stamped into the card.
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Credit Card
Verification
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do not submit with
this field blank
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the last 3
numbers on the BACK of your card
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Billing Address
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The
address that your credit card bill goes to. NOT your brokers address.
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City, State
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Zip Code
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5+4 eg. 20877-1234
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Choose a Service Level
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Basic
Select
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please
refer to our prices page
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Accessories provided by
you
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Main
Panel Name
Rider For
Sale Rider
Under
Contract Rider Sold
Rider
Brochure Box For
Rent Rider
www Rider Other
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Please
check those items you will be providing to us to warehouse for you.
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Initial Setup
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Main
Panel For
Sale Rider Name
Rider
www Rider Brochure
Box Other
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Please
check those items you want us to install on every property that YOU are going
to provide to us.
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Post Color
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White
Peach Brown
Yellow Gray
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Choose
your post color
Check with your broker
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Other
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Anything
else, not covered by options on form. (Make it short)
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