Office Participant Change

Office Participant Change
This form is used when an office designates a new Broker-in-Charge/Participant for BSCMLS purposes.

Previous Participant authorization is not required. By signing this form, the individual identified below acknowledges that they are assuming responsibility as the BSCMLS Participant for the office listed below, subject to BSCMLS approval and verification.
Office Name
Office Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
New BSCMLS Participant / Broker in Charge Name

First NameLast Name
New BSCMLS Participant / Broker in Charge Name MLS User ID
New BSCMLS Participant / Broker in Charge Name License Number
New BSCMLS Participant / Broker in Charge Name Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
New BSCMLS Participant / Broker in Charge Name Email Address
example@example.com
Requested Effective Date

MonthDayYear
Participant Responsibility Acknowledgment
By signing below, I acknowledge that I am requesting to be designated as the BSCMLS Participant/Broker-in-Charge for the office identified in this form. I understand that, for BSCMLS purposes, the Participant is the individual responsible for the office and its affiliated users. I acknowledge that I am responsible for compliance with BSCMLS Rules and Regulations, policies, procedures, MLS system use, listing administration, data accuracy, subscriber activity, and any applicable MLS obligations associated with the office. I understand that use of MLS information is limited to activities authorized by my license and that this MLS administrative designation does not authorize activities beyond my license or applicable law. I understand that BSCMLS may rely on this acknowledgment to update office records, office roster responsibility, listing administration, billing responsibility, MLS system access, and related administrative records associated with the office.
Certification and Signature
I certify that the information provided in this form is accurate and complete. I acknowledge that I am authorized to assume responsibility as the BSCMLS Participant/Broker-in-Charge for the office identified above and agree to comply with all applicable BSCMLS Rules and Regulations, policies, procedures, and administrative requirements associated with that role.
Signature
Should be Empty:

Office Participant Change

Participant Responsibility Acknowledgment

Certification and Signature