Real Estate Agent Online Application Form 100% commission. No hidden fees. Errors and Omissions (E&O) Insurance included. It can’t get any better than this! Step 1 of 4 Progress 25% "*" indicates required fields Agent Profile Name* First Middle Last Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email Address* Mobile Number*Emergency Contact Person* Emergency Contact Number*RE License Number* How do you want Realty Hub to pay your real estate commission?* Paid to My Personal Name Paid to My Corporation SSN We are asking for your SSN in lieu of filling out a W9. If you prefer to fill out the W9, you can download the W9 form at the end of this application process and email it to us.Corporation Name* EIN* Which local Realtor Association are you a current member of?*Please select..Bartow Board of RealtorsBeachesMLSBroward, Palm Beaches & St. Lucie Realtors®Central Pasco Realtor® Organization (CPRO)Daytona Beach Area Association of RealtorsEmerald Coast Association of Realtors (ECAR)Englewood Area Board of Realtors (EABR)Flagler County Association of Realtors (FCAR)Gainesville-Alachua County Association of RealtorsGreater Fort Lauderdale Realtors (GFLR)Greater Tampa Realtors (GTR)Hernando County Association of Realtors (HCAR)Miami Association of RealtorsNaples Area Board of Realtors (NABOR)Northeast Florida Association of Realtors (NEFAR)Ocala/Marion County Association of Realtors (OMCAR)Orlando Regional Realtor Association (ORRA)Osceola County Association of Realtors (OSCAR)Pensacola Association of Realtors (PAR)Pinellas Realtor® Association (PRO)Realtors Association of Citrus County (RACC)Realtors Association of Franklin & Gulf Counties (RAFGC)Realtors Association of Lake & Sumter Counties (RALSC)Realtors Association of the Palm Beaches (RAPB)Realtors Association of Sarasota & Manatee (RASM)Realtors of Punta Gorda-Port Charlotte-North Port-DeSotoRoyal Palm Coast Realtor AssociationSouth Broward Board of Realtors® (SBBOR)Space Coast Association of Realtors (SCAR)St. Augustine & St. Johns County Board of RealtorsTallahassee Board of Realtors (TBR)Are you working Full Time or Part Time in real estate?* Full Time Part Time Referral Program/Hang My License Do you hold any Professional Designations? (CCIM, GRE, etc.)* Yes No Please provide details* Are you engaged in any business enterprise, professional practice or services other than real estate sales?* Yes No Please provide details* Do you own, manage, or control any other entity, including any subsidiary?* Yes No Please provide details* a. Do you refer clients to such entity?* Yes No b. Is written disclosure of such ownership, management, or control provided to each client referred?* Yes No Have you been subjected to a felony conviction, license surrender or been subjected to any investigation, license revocation, suspension or other disciplinary action by any licensing board, real estate association, or other regulatory body within the past 5 years?* Yes No Please provide details* Have you been subjected to any lawsuits and Errors and Omission Insurance Policy claims in the past 5 years?* Yes No Please provide details* NameThis field is for validation purposes and should be left unchanged. We provide the keys to your business. You provide the keys to their new home. 100% Commission.
