AGENT CHANGE FORM - birminghamrealtors.comRevised October 2017 AGENT CHANGE FORM Birmingham...

Revised October 2017

AGENT CHANGE FORM Birmingham Association of REALTORS® / Greater Alabama Multiple Listing Service

3501 Independence Drive, Birmingham, AL 35209 Phone: (205) 871-1911 • Fax: (205) 802-6070 • Email: membership@birminghamrealtors.com

AGENT INFORMATION (This section must be completed for request to be processed):

XXX/XX/ AgentName(Mr./Mrs./Ms.) PreferredName Last4digitsofSSN

RealEstateLicense# EmailAddress(RequiredforAssociationNoticesandMLSUse)

HomeAddress City/State/Zip CountyofResidence

HomePhone(withareacode) CellPhone(withareacode) OfficePhone(withareacode)

CHANGE REQUEST – AGENTSTATUSWILLBEVERIFIEDWITHARECWEBSITEBEFORESTATUSWILLBECHANGED

TRANSFERAGENTNAMEDABOVE:

FROM: TO: CompanyName(pleaseprint) CompanyName(pleaseprint)

ThefollowingTransferFeesmustaccompanythisform:$25PayabletotheBirminghamAssociationofREALTORS®(BAR)$25PayabletotheGreaterAlabamaMultipleListingService(MLS)

SignatureofTransferringAgent Date

BROKER’SCERTIFICATION(Required):IagreethatasalicenseeofmyfirmIamresponsibleforthefinancialobligationsofthismember.IunderstandthatifmyfirmsubscribestotheMLS,allmyagentswhoengagetoanydegreeinresidentialsalesareconsideredactiveinMLSandmustpayMLSdues.Iherebyunconditionallyguaranteepaymentofallfees,dues,finesorotheramountsowedorduefromtheabove-namedagenttotheBARortheMLS.IherebyauthorizeMLStoreceivelistingscontaininglockboxesfromthesalesassociatenamedaboveandcertifythatIhaveexplainedtothemtheresponsibilitiesandpotentialliabilitiesoflockboxuse.IalsoagreetopaytheattorneyfeescourtcostsandotherlegalexpensesofBARorMLSintheeventeitheremploysanattorneyorinitiateslegalproceedings,tocollectfrommeanyamountsthatIhaveguaranteedhereinandthatarepastdue.

BrokerName(pleaseprint): CompanyName(pleaseprint):

SignatureofBroker Date

DELETEAGENTNAMEDABOVEto(checkoneorboth): BAR MLS

BrokerName(pleaseprint): CompanyName(pleaseprint):

SignatureofBroker Date

oIhavereturnedthisLicensetotheAREC oAgentgoing“Inactive” oAgenttransferringtoanothercompany/goingintoReferral

PAYMENT INFORMATION TOTALAMOUNTDUEANDPAYABLEWITHTHISAPPLICATION: ToBAR$ ToMLS$

Topaybycreditcard,pleasecompletethefollowing:qVISAqMasterCardqAmericanExpressqDiscoverCard# ExpirationDate CVC

Nameoncard Signature