Hancock-Washington Board of REALTORS®
Application for Designated Brokers/Branch Managers Membership FormDesignated brokers and branch managers must complete both the REALTOR® MEMBERSHIP form and the Designated Brokers/Branch Managers form. Fill both pages in manually and mail it with your check to the Board Office. DO NOT MAKE ANY CHANGES TO THIS BASIC FORM.
Does your company comply with zoning requirements for its location?____
Company Information: ___Individual ___DBA ___Partnership ___Corporation
Your position: ___Principal ___Partner ___Corporate Officer ___Trustee ___Employee ___Independent Contractor ___Other:_________________________Names of Principles/Partners/Officers/Trustees of your firm:
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Have you ever been refused membership in any other real estate Board/Council?_____ If yes, state the basis for each such refusal and detail the circumstances related thereto:_____________________________________________________
Is the office address, as stated, your principal place of business?_____
If not, or if you have any branch offices, please indicate and give address(es):_________________________________________________________________In what areas of real estate do you specialize?_________________________________________________________________
Principals, please list institution in which you maintain your escrow account:__________________________________________________________
Do you hold, or have you ever held, a real estate license in any other state?____ If so, where?________________________
Have there been any complaints, within the last five years, against you or the firm with which you are associated?___ If so, please specify:
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_________________________________________________________________I hereby certify that the foregoing information furnished by me is true and correct, and I agree that failure to provide complete and accurate information as requested, or any misstatement of fact, shall be grounds for revocation of my membership if granted. I further agree that, if accepted for membership in the Board, I shall pay the fees and dues as from time-to-time established. NOTE: Payments to the Hancock-Washington Board of REALTORS® are not deductible as charitable contributions. Such payments may, however, be deductible as an ordinary and necessary business expense. No refunds.
Dated:_____________ Signature: ______________________________________
Mail to:
63 Foster Street, Suite One
Ellsworth, ME. 04605-2101
Telephone 207-667-8668 Fax 207-667-6777
Executive Officer: Beverlee C. Beers