Date: ____________
MEMBER/OFFICE INFORMATION CHANGE FORM
FAR/FMLS WILL NOT BE RESPONSIBLE IF INCORRECT INFO IS PROVIDED
FOR STAFF USE ONLY
_____________________________________________ Updated Supra _______
STAFF SIGNATURE Scanned ____________
Member Name: ___________________________________________ Member #: ___________________
DRE License #: __________________________ NRDS #: ___________________________________
Member Profile Update
OLD Member Information:
Home Address: ________________________________________________________________________
E-mail Address: ________________________________________________________________________
Web Address: _________________________________________________________________________
Home Phone #: _________________________________ Cell Phone #: ___________________________
Fax #: _______________________________________
New Member Information:
Home Address: ________________________________________________________________________
E-mail Address: ________________________________________________________________________
Web Address: _________________________________________________________________________
Home Phone #: _________________________________ Cell Phone #: ___________________________
Fax #: ______________________________________
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Office Transfer
¥
Member has listings to be transferred to new office? YES NO *Requires a Listing Transfer Form if “YES”
OLD Office Information:
Office Name: __________________________________________ Office #: ________________________
Office Address: ________________________________________________________________________
Office Phone #: ____________________________ Office Fax #: _________________________________
New Office Information:
Office Name: __________________________________________ Office #: ________________________
Office Address: ________________________________________________________________________
Office Phone #: ____________________________ Office Fax #: _________________________________
_____________________________________ ________________________________________
SIGNATURE OF MEMBER SIGNATURE OF BROKER
*¥
* Broker signature not required for Member Profile Update
¥ Broker signature required for Office Transfer
