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: [email protected]
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