Associate Information Form
Please note: In accordance with the Bylaws of South Shore REALTORS®, Inc. Article VI, Section 6, REALTOR®
Principals are required and must notify the Association in writing within five (5) days of an Agent’s Office
association or disassociation.
Today’s Date: Agent Start Date_____________
Please make the following change for the Agent listed on this form:
Add this NEW agent to our roster and send an application and dues invoice. (Never been a REALTOR®.)
______to South Shore REALTORS®.
____to the Office listed below.
_____(date).
Transfer this Agent from the following Realtor® Association:
Transfer this Agent from
Disassociate this Agent from our Office roster as of
Reinstate this Agent to South Shore REALTORS® ‐ Agent was a member in
_____(date).
AGENT NAME
Home Address
Home City State Zip Code
Home Telephone Mobile Date of Birth
E‐Mail Address
Real Estate License Number Sales / Broker
OFFICE NAME
Office Address
Office City State Zip Code
Office Telephone Fax
Designated REALTOR®/Broker Owner Name
Designated REALTOR®/Broker Owner SIGNATURE
48 Schoosett Street, Pembroke, MA 02359
P. 781‐826‐5139
www.SouthShoreRealtors.com
info@SouthShoreRealtors.com
Add as SECONDARY member, currently PRIMARY with Realtor® Association:________________________
