400 Club Member Information Form

All Members must complete this form, provide a valid copy of their Drivers License, Real Estate License and Board of Realtors Membership Card. If you are not a member of the Real Estate Board and MLS, you must complete the Non Realtor Independent Contractors Agreement in order to keep you license active.  

Click the links on the left hand side of this page and complete a W-9, Sign our independent Contractors Agreement and email copies of your Identifications to Broker James at Jrena10@gmail.com.

2017 Member Information
Name *
Name
Phone
Phone
Birthdate Date
Birthdate Date
Direct Pay Information
1099 Employee Tax Information
If you are being paid as a company you will need to provide your companies address and TIN number.
This is only needed if you are being paid as a company and not as an individual.
This is only needed if you are being paid as a company and not as an individual.