Chicago Listing Registration Form

Listing & Disclosure Registration Form
Agent Name
Agent Email
Agent Phone Number
Property Address:
Client/Signatory Name #1
Entity Name If Applicable
Client #1 Email
Client/Signatory Name #2
Client #2 Email
Seller Address - If Different from the Subject Property
How would you like Disclosures sent?
If completing Disclosures Electronically, which Seller should input subjective information?
Which Forms Are Needed?

Lead Based PaintRadonPrivate NetworkReal Property DisclosureMRED Exemption
Would you like us to order the Heating Disclosure?

YesNo
If using the MRED, which selection should be made for Section 9?

9A - input number of calendar days in note field below9B - input date in note field below9C - specify service in note field below9D - Do not submit Property to the MLS during the entire listing provided for in the Agreement9E - Do not submit Property to the MLS until given further written notice
Additional Language for MRED Selections 9A, 9B, or 9C:
For Private Listing Network Form - Place on the MLS in Private Status:

within 24 hoursor on a specific date (see below)
Date to Enter on MLS:
For Private Listing Network Form - Please Choose One

SHOW the Listed Property to prospective buyers, tenants and/or their brokers, orDo not SHOW the Listed Property to prospective buyers, tenants and/or their brokers (including Owner’s Sponsoring Broker)
For Private Listing Network Form - Please Choose One

SHARE the details of property to prospective buyers, tenants and/or their brokers, orDo not SHARE the details of property to prospective buyers, tenants and/or their brokers (including Owner’s Sponsoring Broker)
If using NSBAR Private Listing Network (PLN) Form - Please Choose One

a. Submit immediately to PLN, then remove and place on MLS on the following dateb. Submit to PLN, but don't remove and place on MLS until Seller advises in writingc. Submit to PLN, and do not move to MLS during entire Listing/Marketing period
If 'a' is Selected - Date to Enter on MLS:
If 'c' is Selected - Should Property be available for viewings while on PLN?

YesNo
Tax Pin - Primary
Tax Pin - Additional
Commission Amount or Percentage*
List Price
Year Built
Property Type
Set client up on 360 Home Connect?

YesNo
For more information, click the following link:

360 Home Connect
Additional Notes or Instructions
Should be Empty:

Listing & Disclosure Registration Form