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
*
Please Select
January
February
March
April
May
June
July
August
September
October
November
December
Greater Midwest Realty Start Date
*
-
Month
-
Day
Year
** WE WON'T TRANSFER YOUR LICENSE UNTIL YOU TELL US TO DO SO **
Email:
*
Phone #
*
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
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1952
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1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
MN/WI Real Estate License #
*
NRDS #:
What Realtor Association do you belong to?
*
St. Paul (SPARR)
Minneapolis (MAAR)
Lake Superior (LSAR)
Emergency Contact Name:
*
First Name
Last Name
Emergency Contact #
*
Please enter a valid phone number.
Agent Plan (Please Pick one)
Agent Initials
*
Signature using your Mouse
*
Date
*
-
Month
-
Day
Year
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 #
*
Account Type:
*
Checking
Savings
Do you want to pay your monthly fees by credit card? ** CREDIT/DEBIT CARD PAYMENTS ARE SUBJECT TO A 3.5% PROCESSING FEE ** We will send you a separate credit card form to fill out.
YES
NO
THIS NEXT PORTION COVERS YOUR W9 FOR YOUR 1099 END-OF-YEAR STATEMENT, & WHO WE WILL MAKE YOUR COMMISSION CHECKS PAYABLE TO
Name
*
First Name
Last Name
Name as shown on your income tax return (If business entity please business entity name)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
W9 Tax Classification
*
Individual
LLC: Sole Proprietor or Single Member LLC
S Corp
C 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
Preview PDF
Submit
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