GMR ENROLLMENT APPLICATION (CURRENTLY LICENSED)

THIS WILL TAKE APPROXIMATELY 15 MINUTES TO COMPLETE
PLEASE REVIEW THE INDEPENDENT CONTRACTOR AGREEMENT BEFORE FILLING OUT THE FORM BELOW
Agent's Name: *
Contract Day*
Contract Month*
Greater Midwest Realty Start Date*

MonthDayYear
** WE WON'T TRANSFER YOUR LICENSE UNTIL YOU TELL US TO DO SO **
Email: *
Phone #*
Format: (000) 000-0000.
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
MN/WI Real Estate License #*
NRDS #:
St. Paul (SPARR)Minneapolis (MAAR)Lake Superior (LSAR)
Emergency Contact Name:*

First NameLast Name
Emergency Contact #*
Please enter a valid phone number.Format: (000) 000-0000.
Agent Plan (Please Pick one)
Agent Initials*
Signature using your Mouse*
Date*

MonthDayYear
Date
Referral Agent's Name:
** THIS AGENT WILL GET A $100 REFERRAL COMMISSION FOR EVERY TRANSACTION YOU COMPLETE, PAID BY GMR, SO LONG AS YOU"RE BOTH AGENTS AT GMR **
Direct Deposit Credit & Debit Authorization

THIS NEXT PORTION HELPS US SETUP YOUR ACH FOR COMMISSION DEPOSITS AND MONTHLY BILLING ** A $20.40 TRANSFER FEE FROM THE STATE WILL BE ADDED TO YOUR NEXT INVOICE
Bank Name:*
Routing #*
Account #*
CheckingSavings
YESNO
THIS NEXT PORTION COVERS YOUR W9 FOR YOUR 1099 END-OF-YEAR STATEMENT, & WHO WE WILL MAKE YOUR COMMISSION CHECKS PAYABLE TO
Name*

First NameLast Name
Name as shown on your income tax return (If business entity please business entity name)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
IndividualLLC: Sole Proprietor or Single Member LLCS CorpC Corp
Social Security #*
EIN #
** BEFORE YOU HIT SUBMIT, CLICK PREVIEW PDF & MAKE SURE YOU FILLED OUT FORM CORRECTLY **

When you hit submit you will receive a copy of the filled out documents by email
Should be Empty:

THIS WILL TAKE APPROXIMATELY 15 MINUTES TO COMPLETE

PLEASE REVIEW THE INDEPENDENT CONTRACTOR AGREEMENT BEFORE FILLING OUT THE FORM BELOW

Direct Deposit Credit & Debit Authorization

THIS NEXT PORTION COVERS YOUR W9 FOR YOUR 1099 END-OF-YEAR STATEMENT, & WHO WE WILL MAKE YOUR COMMISSION CHECKS PAYABLE TO

** BEFORE YOU HIT SUBMIT, CLICK PREVIEW PDF & MAKE SURE YOU FILLED OUT FORM CORRECTLY **

BEFORE YOU HIT SUBMIT, CLICK PREVIEW PDF & MAKE SURE YOU FILLED OUT FORM CORRECTLY