THIS WILL TAKE APPROXIMATELY 25 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
Email:
*
example@example.com
Phone #
*
Please enter a valid phone number.
Format: (000) 000-0000.
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
2026
2025
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
1953
1952
1951
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
What Realtor Association would you like to join?
*
St. Paul (SPAAR)
Minneapolis (MAAR)
LAKE SUPERIOR (LSAR)
Emergency Contact Name:
*
First Name
Last Name
Emergency Contact #
*
Please enter a valid phone number.
Format: (000) 000-0000.
Agent Plan Choice (Please click 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 $117.50 new agent 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, AND 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 #
THIS NEXT PORTION GOES OVER 9 QUESTIONS YOU MUST ANSWER TO BECOME A REAL ESTATE AGENT
1. Have you ever been convicted of a crime, had a judgment withheld or deferred, or have you been charged with committing a crime?
*
YES
NO
If you answered yes to the about questions please explain:
2. Have you or any business in which you are or were an owner, partner, officer or director, or member or manager of LLC, ever been involved in an administrative proceeding regarding any professional or occupational license, or registration?
*
YES
NO
If you answered yes to the about questions please explain:
3. Has any judgment been rendered against you or any business in which you are or were an owner, partner, officer, director , or member or manager of LLC, for overdue monies, or have you been subject to a bankruptcy proceeding?
*
YES
NO
If you answered yes to the about questions please explain:
4. Have you been notified by any jurisdiction to which you are applying of any delinquent tax obligation that is no the subject of a repayment agreement? If you answer YES, identify the jurisdictions:
*
YES
NO
If you answered yes to the about questions please explain:
5. Have you ever been a party to, a defendant, or found liable in a lawsuit or arbitration processing involving allegations of fraud, misappropriation or conversion of funds, misrepresentation, breach of fiduciary duty, or breach of contract?
*
YES
NO
If you answered yes to the about questions please explain:
6. Do you have child support obligation in arrearage?
*
YES
NO
If you answered yes to the about questions please explain:
7. Have you ever been licensed as a real estate broker or Salesperson in any state other than MN?
*
YES
NO
If you answered yes to the about questions please explain:
8. Are you currently an owner, officer or partner of a licensed Real Estate Company through which you will be licensed?
*
YES
NO
If you answered yes to the about questions please explain:
9. Do you have any unclaimed property to report under MN statutes 345.37?
*
YES
NO
If you answered yes to the about questions please explain:
Please upload the following documents: 1. Copies of your course 1,2, and 3 completion certificates 2. Passed exam sheets from the state and national exams
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