AGENT INFORMATION
Legal Name:
*
First Name
Last Name
Preferred Name (Leave black if this is the same as your legal name.):
First Name
Last Name
Birth Date
*
-
Day
-
Month
Year
Date
Current Home Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Personal Email Address:
*
example@example.com
Mobile Phone:
*
Please enter a valid phone number.
Which office location best suits your business needs?
*
Pace
Perdido Key
Downtown Pensacola
Portofino
Are you joining a team?
*
Yes
No
Please list the team name or team lead.
*
Social Media
Facebook Business Page URL:
Not Required. This can be provided at a later date.
Instagram Business Handle:
Not Required. This can be provided at a later date.
LinkedIN Profile:
Not Required. This can be provided at a later date.
Youtube Channel URL:
Not Required. This can be provided at a later date.
If you have a professional headshot, please upload that here:
Browse Files
Drag and drop files here
Choose a file
If you do not have a headshot, at no cost to our Realtors, we have partnered with WAVE Photo by Aislinn Kate in order to bring our agents an outstanding photography experience. We will provide details at a later date.
Cancel
of
If you have a personal logo, please upload that here:
Browse Files
Drag and drop files here
Choose a file
This can be provided later.
Cancel
of
Do you have a professional biography you would like to use at this time?
This can be provided later.
REAL ESTATE LICENSE
Which state(s) do you hold a real estate license in? - You can select more than 1.
*
Florida
Alabama
Florida Real Estate License Number:
*
Alabama Real Estate License Number:
*
Which MLS association(s) are you an active member of?
*
PAR MLS
NABOR MLS
ECAR/FLEX MLS
Baldwin Realtor MLS
I am newly licensed.
PAR MLS ID#:
*
NABOR MLS ID#:
*
ECAR/FLEX MLS ID#:
*
Baldwin Realtor MLS ID#:
*
I am newly licensed and will be joining:
*
Please provide the MLS Association that you will be joining.
Total active years in real estate:
*
NRDS ID number:
If you do not know your NRDS ID Number, that can be found here: https://login.connect.realtor/#!/forgotmember
Do you have any active listings you plan to transfer to LRR? - this should trigger second template - Include Listing Release
Yes
No
CREDIT CARD AUTHORIZATION
Preferred Billing Method:
*
Credit Card
Debit Card
Preferred Billing Schedule:
*
on a recurring, monthly basis as payment for monthly dues (agent choice)
on a one-time monthly basis if agent has a balance outstanding over 90 days.
on a one-time basis if agent leaves Levin Rinke Realty and has an outstanding balance.
Credit Card Type:
*
Mastercard
Visa
American Express
Discover
Other
Please provide the credit card type.
*
If you did not intend to select "other", click back and choose another option.
Credit Card Number:
*
*NOTE: In compliance with PCI standards, you will be contacted via the phone number on file to request your card CVV.
MM
blanks
*
/ YY
blank
*
DIRECT DEPOSIT
Account Type:
*
Checking Account
Savings Account
Bank Name
*
Account Number:
*
Bank Routing Number:
*
Bank City,State:
*
W9
Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven options.
*
Individual/sole proprietor or single-member LLC
C Corporation
S Corporation
Partnership
Trust/estate
Limited liability company. This will require you to add the tax classification.
Other
If you selected: Limited liability company, Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)
*
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is NOT disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.
EMERGENCY CONTACT
Full Name
First Name
Last Name
Relationship
Phone Number:
Please enter a valid phone number.
MARKETING
Email Signature Preference:
*
Business Card Preference:
*
Do you have any special designations you would like to include on your business card and email signature?
For example: CRP, MRP, PA, or Broker Associate
What website would you like listed on your business cards and email signature?
NOTE: This should be your delta site unless you have a vanity URL.
What email address would you like listed on your business cards and email signature?
example@example.com
Which office location would you like listed on your business cards? - This also may be something we ask about on the paperwork so we may need to remove it.
Downtown - 220 W Garden St. Suite 125, Pensacola FL, 32502
Portofino - 10 Portofino Drive, Pensacola Beach, FL 32561
Perdido Key - 14112 Perdido Key Drive, Perdido Key, FL, 32507
Pace Office - 5631 Woodbine Rd., Pace, FL 32571
What size polo shirt would you like?
XS
S
M
L
XL
2XL
3XL
4XL
Is your mailing address different from your home address that you provided already?
Yes
No
Mailing Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If there is any other information we need to know regarding your onboarding materials and marketing, please let us know here!
Submit
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