Application Form For Realtor And Broker Membership
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3HARFORD COUNTY ASSOCIATION OF REALTORS®, Inc.
APPLICATION FOR REALTOR® and BROKER MEMBERSHIP
All Applicants are required to complete and sign this application.
Return completed application to:
HARFORD COUNTY ASSOCIATION OF REALTORS®, INC.
P.O. Box 802, Bel Air, MD 21014-0802
Phone: 410-569-0750
FAX: 410-569-9654
I hereby apply for Primary ___ Secondary ____
membership with the Harford County Association of REALTORS®.
COMPLETE ONLINE, PRINT CLEARLY, OR TYPE ALL INFORMATION
Prefix: ___Mr. ___ Mrs. ___Ms. ___Miss
Name as shown on your real estate license:
First Name: ___________________ Middle Name: _______________ Last Name:_________________
Suffix: _____________________________
Nickname: ______________________________________
Date of Birth: ________________________
License No._________________________ License Expiration Date: ___________________________
Name of Office:_______________________________________________________________________
Office Address: _______________________________________________________________________
Office Phone: ________________________ Office FAX: _____________________________________
Name of your Office Broker/Manager: _____________________________________________________
Home Address: ______________________________________________________________________
Home Phone: ________________________ Mobile Phone: __________________________________
Your Email Address: ___________________________________________________________________
License Type: Broker: ___ Associate Broker: _____ Salesperson:_____ Commercial: ____ Other:_____
Date you first entered the real estate business: _________________
_____________________
Date
State
List any current REALTOR® Designations held: _____________________________________________
List any other states where your license is active:____________________________________________
Has your real estate license ever been suspended or revoked? ___ YES ___ NO
Do you have any pending complaints with any REALTOR® association? ___ YES
____ NO
List REALTOR® Board/Associations where you held membership in the past three years or are
transferring from: _____________________________________________________________________
___________________________________________________________________________________
2015 REALTOR®/Broker Application
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