Fillable Form 5: REALTOR Membership Application

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Form 5: REALTOR Membership Application

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REALTOR® Membership Application
I
hereby
apply
for
REALTOR®
Membership
in
the
Greater
Bergen REALTORS® and am enclosing my payment
in the
amount
of
$__________
(
see
REALTOR®
Prorated
Dues
Schedule).
Fees
are
nonrefundable.I
will attend
orientation
and
complete
the
on-line
New
Member
Code
of
Ethics
Training
of
the
NATIONAL
ASSOCIATION
OF
REALTORS®
within
90
days
of
confirmation
of
provisional
membership.
Failure
to
meet
this
requirement
may
result
in
having
my
membership
terminated.
I
agree
to
abide
by
the
Code
of
Ethics
of
the
NATIONAL
ASSOCIATION
OF
REALTORS®,
which
includes
the
duty
to
arbitrate,
and
the
Constitutions,
By-laws
and
Rules
and
Regulations
of
the Greater
Bergen
REALTORS®,
the
State
Association
(NJR)
and
the
National
Association
(NAR).
YOU MUST INCLUDE A COPY OF YOUR CURRENT VALID NJ REAL ESTATE LICENSE
Gender: Male Female
Date of Birth:
(Month/Day/Year) ____________________
Are you fluent in any other language(s) besides English? Yes No
If Yes, please indicate the language(s): ____________________________________________________________
Name as it appears on your Real Estate or Appraiser’s license:
First Name: ________________________ Last Name: __________________________ Middle Name: ____________________
Real Estate License #: ___________________________________________ Last 4 Digits of SS#: ________________________
Please Check One: __ Broker __ Salesperson __ Appraiser
Membership type: __ Primary __ Secondary
(Transferring or Secondary applicants must include Letter of Good Standing with application)
Firm Name: _________________________________________________________________________________________________
Office Address: _____________________________________________________________________________________________
Office City/State/Zip: _______________________________________________________________________________________
Office Phone: __________________________________________ Office Fax: _________________________________________
Home Address: _____________________________________________________________________________________________
City/State/Zip: ______________________________________________________________________________________________
Cell Phone: _______________________________ Home Phone: _____________________________
Email Address (required):____________________________________________________________________________________
Voluntary Information
Member Information
411 Route 17 South 5th Fl
Hasbrouc k Heights, NJ 07604
Phone:
201-244-7000
Fax:
201-288-0511
Email:zelina
@greaterbergenrealtors.com
5
Franklin
Turnpike
Waldwick,
NJ
07463
Phone:
201-244-7000
Fax:
201-444-6368
Email:
ashley@greaterbergenrealtors.com
www.greaterbergenrealtors.com
Preferred Mailing Address: __ Home __ Office Preferred Phone: __ Home __ Office __Cell
Previous board/association membership? __ Yes __ No
If yes, please list your NRDS #:________________________________
Has your real estate license, in this or any other state, been suspended or revoked? __ Yes __ No
(If yes, provide details as an attachment.)
Have you been found in violation of the Code of Ethics or other membership duties in any Association of
REALTORS® in the past three years or are there any such complaints pending? __ Yes __ No
(If yes, provide details as an attachment.)
Signature
I agree to the following membership conditions:
I consent and authorize the Board, through its Membership Committee or otherwise, to invite and receive
information and comments about me from any Member or other person, and agree that any information and
comments, furnished to the Board by any Member or other person, in response to any invitation, shall be
conclusively deemed to be privileged and not form the basis of any action against the Board, by me, for slander,
libel or defamation of character.
To arbitrate business disputes in accordance with the Code of Ethics and Arbitration Manual of the Association as
time to time amended.
To pay the fees and dues as established.
To discontinue the term “REALTOR®” in the event that my membership is terminated or suspended for any
cause. I hereby consent to receive fax and e-mail transmissions from Greater Bergen of REALTORS®, New Jersey
Association of REALTORS® and the National Association of REALTORS® to my fax and e-mail addresses as set
forth above.
____________________________________________________ _________________________________________________
Signature of Applicant Date
I certify that the above named applicant holds the license, as indicated, which is in my possession and on display
in my office at:
Office Street Address:
___________________________________________________________________________________________________
Office City/State Zip:
____________________________________________________________________________________________________
Firm Name: ________________________________________________________________
Phone:___________________________________
___________________________________________ ____________________________________
REALTOR® (Signature of Licensed, Employing Broker) Date
To Be Completed By the Licensed Employing Broker
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One Time Credit Card Payment Authorization Form
Please complete the information below:
I authorize GBR to charge my credit card account This
payment is for the GBR Membership Dues
Billing Address ____________________________ Phone# ________________________
City, State, Zip ____________________________ Email ________________________
Purchase Total
_______________________________________________________________________
CREDIT CARD
Account Type: Visa MasterCard AMEX Discover
Cardholder Name _________________________________________________
Account Number _____________________________________________
Expiration Date ____________
CVV (3 digit number on back of Visa/MC, 4 digits on front of AMEX) ______
SIGNATURE DATE ________________
I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined
above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for
one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card
company; so long as the transaction corresponds to the terms indicated in this form.
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*RPAC contributions are voluntary and used for political purposes
*Care Foundation contributions are voluntary donations
411 Route 17 South 5th Fl Hasbrouck Heights, NJ 07604
201- 244-7000
Email: zelina@greaterbergenrealtors.com
5
Franklin
Turnpike
Waldwick,
NJ
07463
201-244-7000
Email:
ashley@greaterbergenrealtors.com
www.greaterbergenrealtors.com
Month
Joining
Application
Fee
GBR
Dues
NJAR
Dues
NAR
Dues
*RPAC
Fair Share
*Care
Foundation
Total
January
$150.00 $190.00 $140.00 $185.00 $25.00 $10.00
$700.00
February
$150.00 $190.00 $140.00 $172.50 $25.00
$10.00
$687.50
March
$150.00 $190.00 $140.00 $160.00 $25.00
$10.00
$675.00
April
$150.00 $142.50 $106.25 $147.50 $25.00
$10.00
$581.25
May
$150.00 $142.50 $106.25 $135.00 $25.00
$10.00
$568.75
June
$150.00 $142.50 $106.25 $122.50 $25.00
$10.00
$556.25
July
$150.00 $95.00 $72.50 $110.00 $25.00
$10.00
$462.50
August
$150.00 $95.00 $72.50 $97.50 $25.00
$10.00
$450.00
September
$150.00 $95.00 $72.50 $85.00 $25.00
$10.00
$437.50
October
$150.00 $47.50 $38.75 $72.50 $25.00
$10.00
$343.75
November
$150.00 $47.50 $38.75 $60.00 $25.00
$10.00
$331.25
December
$150.00 $47.50 $38.75 $47.50 $25.00
$10.00
$318.75
2021
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Form 5: REALTOR Membership Application

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Completed 12 April 2021

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