Agent and Broker Application
Section 1: Personal Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Section 2: Licensing Information
Which state(s) are you licensed in?
*
Please Select
New Mexico
Utah
License Number
*
Have you ever had a license suspended, revoked, or been subject to disciplinary action?
*
Yes
No
If yes, please explain
Section 3: Current Brokerage Status
Current Brokerage Name
*
Notice Period Required
*
Please Select
Immediate
30 Days
60 Days
90 Days
If Other, specify:
Anticipated Separation Date
*
-
Month
-
Day
Year
Date
Current Status
*
Please Select
Active
Giving Notice
Already Separated
Never Affiliated
Section 4: Production History
How many years have you been in real estate?
*
Last 12 Months - Number of Transactions Closed
*
Primary Geographic Area(s) of Focus
*
Property Types
*
Residential
Commercial
Land
Luxury
New Construction
Other
Section 5: E&O Insurance
Current E&O Carrier
*
Will you maintain individual policy or switch to company policy?
*
Please Select
Yes
No
Section 6: Business Structure
Are you operating as an individual or team?
*
Please Select
Individual
Team
If Team - Team Name
If Team - Team Member Names and Roles
Business Entity Type
*
Please Select
Sole proprietor
LLC
S-Corp
C-Corp
Partnership
If entity, Legal Entity Name:
Section 7: About Your Move
What attracted you to Waypoint Noven?
*
What are your transaction goals for the next 12 months?
*
What are your volume goals for the next 12 months? ($)
*
How did you hear about Waypoint Noven?
*
Please Select
Website
Referral
Social media
Recruiting call
Event
Other
If Referral, who referred you?
Section 8: Compliance Questions
Have you ever had a real estate license suspended or revoked in any state?
*
Please Select
Yes
No
Are there any pending disciplinary actions against your license?
*
Please Select
Yes
No
Have you filed for bankruptcy in the last 7 years?
*
Please Select
Yes
No
Have you been convicted of a felony?
*
Please Select
Yes
No
If yes to any above, please explain:
Section 9: Acknowledgments
I am currently licensed and in good standing in the state(s) indicated above
*
Confirmed
I understand I cannot execute an Independent Contractor Agreement until I have separated from my current brokerage
*
Confirmed
I understand this is an application only and does not constitute a commitment from either party
*
Confirmed
All information provided in this application is accurate and complete to the best of my knowledge
*
Confirmed
I authorize Waypoint Noven to verify the information provided with state licensing boards and other relevant entities
*
Confirmed
I understand that providing false information may result in immediate disqualification
*
Confirmed
Section 10: Signature
Signature
*
Submit
Should be Empty: