Please complete State Affiliate Broker Application in its entirety. All information shall remain confidential. If you have any questions please let us know by emailing us or by call us toll free, at 1.877.380.1000. Thank you!

State Affiliate Broker OnLine Application Form
Broker/Owner Information
This is the State Affiliate Broker

First Name *

MI

Last Name *

Mailing Address *

City *

State *

ZIP*

Email Address *

Home Phone

( ) -

Work Phone *

Cell Phone

( ) -

Fax Number *

( ) -

 

Company Information
Promotional Information for the Network
Franchise Affiliation *
If "Other" Please Specify Name

Full Company Name *

First Year in Business *

Number of Offices *

Number of Agents *

Number of Listings Annually*

Gross Commission Income Yearly *

 

Your Network Objectives
Maximizing your Network Potential

What is your Primary Objective? *

What is your Secondary Objective? *

What is your Third Objective? *

 
Additional Services
Design your Network for Optimal Performance

Check any of these additional services you Might Need at Some Point in the Future. Select as many as you like. There is no obligation. We will discuss these services with you.

Home Warranties
Transaction Mgmt
 

Additional Questions
Your Current Situation
Do you have a website? *
Yes No
What is the website address? *
www.
Does your site have IDX features? *
Yes No
Do all of your agents have websites? *
Yes No
Do you have a relocation coordinator? *
Yes No
Do you have agents working from home? *
Yes No
Do you have home-based agents in other cities? *
Yes No
Do you own a mortgage company? *
Yes No
Do you own a title/escrow company? *
Yes No
Do you have a Information Technology (IT) person? *
Yes No
When would you like to be operational with e-Partner? *
Please submit your comments or questions
 
 
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