Agent Information Form
(page 1)
Contact Information
Agent First Name
*
Agent Last Name
*
Email Address
*
Company Name
*
Company Address 1
*
Company Address 2
Company City
*
Company State
*
Company Zip Code (xxxxx)
*
Contact Numbers
Office Phone
*
Mobile Phone
Home Phone
Fax Number
Pager Number
Preferred Phone
Office
Mobile
Home
Fax
Pager
Payment Options
Agent Tax ID
*
Payment Type
*
Check
E-Transfer
Bank Routing Number
Bank Account Number
Make Checks Payable To:
Appraisers/Brokers/Realtors Only
Real Estate License Number
*
Real Estate License State
*
Number of sales in last 12 months
Number of BPOs completed in last 12 months
Number of current active listings
Number of REO active listings
Service Proximity
Please Enter The Maximum Number Of Miles You Are Willing To Travel For To Complete A BPO
*
(
*
denotes a required field)