Agent Information Sheet
After submitted, contact Diane Newman to schedule an appointment.
Agent Name
*
First Name
Last Name
Nickname preferred
Joining a Team?
*
Yes
No
Team Name
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Office Name
*
Office Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Office Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Office Fax
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Missouri Real Estate License Number
*
Are you a Salesperson or a Broker?
*
Salesperson
Broker
Birthdate
*
-
Month
-
Day
Year
Date
Spouse's Name
Are you joining OGAR as a PRIMARY or SECONDARY member?
*
Secondary (I am a primary member somewhere else.)
Primary
Have you previously been a REALTOR member at ANY association and issued a NRDS/M1 number?
*
YES
NO
What was the previous NRDS/M1 number?
Name of the Primary Board
NRDS/M1 Number
Submit
Should be Empty: