Fillable New Office Application Form

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New Office Application Form

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The New Office Application Form form is 2 pages long and contains:

  • 1 signature
  • 11 check-boxes
  • 24 other fields

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File type: PDF

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New Office Application Form
Please complete and submit this form when establishing a new office or transferring office affiliation to the Greater Bergen
REALTORS®. There is a one-time $300 processing fee when establishing a new office.
Firm Name: __________________________________________________________________________________
Tax ID: ______________________________________ Corporate License #: ______________________________
Office Address: _______________________________________________________________________________
Office City/State/Zip: _________________________________________________________________________
Office Website: http://_________________________________________________________________________________
Office Phone: ______________Office Fax: ________________Office E-mail:______________________________
Please Check One: __ Main Office __ Branch Office
Company Information: __ Sole Proprietor __ Partnership __ Corporation __ LLC (Limited Liability Company)
__ Other, specify __________________________________________________________
Your Name: __________________________________________________________________________________
Your Position: __ Principal __ Partner __ Corporate Officer __ Majority Shareholder
__ Branch Office Manager __ Nonprincipal Licensee
Name of Designated REALTOR®: _________________________________________________________________
Names of other Partners/Officers of your firm: ______________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
In accordance with the Association’s Bylaws, all above who are licensed real estate brokers actively engaged in the
real estate profession are required to hold REALTOR® Membership.
Have you ever been refused membership in any other Association of REALTORS®?
__Yes __No (If yes, provide details as an attachment.)
Have you or your firm been found in violation of state real estate licensing regulations or other laws prohibiting
unprofessional conduct rendered by the courts or other lawful authorities within the last three years?
__Yes __No (If yes, provide details as an attachment.)
Have you or your firm been convicted of a felony or other crime?
__Yes __No (If yes, provide details as an attachment.)
5 Franklin Turnpike
Waldwick, NJ 07463
Phone: 201-244-7000
Fax: 201-444-6368
Email: ashley@greaterbergenrealtors.com
www.greaterbergenrealtors.com
411 Route 17 South , 5th Fl
Hasbrouck Heights, NJ 07604
Phone: 201-244-7000
Fax: 201-288-0511
Email:
zelina@greaterbergenrealtors.com
Signature
I hereby certify that the foregoing information is true and correct, and I agree that failure to provide complete
and accurate information, or any misstatement of fact, shall be grounds for revocation of my membership, if
granted.
By signing below, I consent that the REALTOR® Associations (local, state and national) and their subsidiaries may
contact me at the specified address, telephone numbers, fax numbers, email addresses or other means of
communication provided. I understand that this consent also applies to changes in contact information that I may
provide the Association(s) in the future.
____________________________________________ ____________________________________
Signature of Applicant Date
www.greaterbergenrealtors.com
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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 Office Fee
Billing Address ____________________________ Phone# ________________________
City, State, Zip ____________________________ Email ________________________
Purchase Total
_______________________________________________________________________
CREDIT CARD
Account Type: Visa MasterCard AMEX Discover
Cardholder Name _________________________________________________
Account Number _____________________________________________
Expiration Date ____________
CVV2 (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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New Office Application Form

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Completed 12 April 2021

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