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Revised October 2017 AGENT CHANGE FORM Birmingham Association of REALTORS® / Greater Alabama Multiple Listing Service 3501 Independence Drive, Birmingham, AL 35209 Phone: (205) 871-1911 • Fax: (205) 802-6070 • Email: [email protected] AGENT INFORMATION (This section must be completed for request to be processed): XXX/XX/ Agent Name (Mr./Mrs./Ms.) Preferred Name Last 4 digits of SSN Real Estate License # Email Address (Required for Association Notices and MLS Use) Home Address City/State/Zip County of Residence Home Phone (with area code) Cell Phone (with area code) Office Phone (with area code) CHANGE REQUEST – AGENT STATUS WILL BE VERIFIED WITH AREC WEBSITE BEFORE STATUS WILL BE CHANGED TRANSFER AGENT NAMED ABOVE: FROM: TO: Company Name (please print) Company Name (please print) The following Transfer Fees must accompany this form: $25 Payable to the Birmingham Association of REALTORS® (BAR) $25 Payable to the Greater Alabama Multiple Listing Service (MLS) Signature of Transferring Agent Date BROKER’S CERTIFICATION (Required): I agree that as a licensee of my firm I am responsible for the financial obligations of this member. I understand that if my firm subscribes to the MLS, all my agents who engage to any degree in residential sales are considered active in MLS and must pay MLS dues. I hereby unconditionally guarantee payment of all fees, dues, fines or other amounts owed or due from the above-named agent to the BAR or the MLS. I hereby authorize MLS to receive listings containing lockboxes from the sales associate named above and certify that I have explained to them the responsibilities and potential liabilities of lockbox use. I also agree to pay the attorney fees court costs and other legal expenses of BAR or MLS in the event either employs an attorney or initiates legal proceedings, to collect from me any amounts that I have guaranteed herein and that are past due. Broker Name (please print): Company Name (please print): Signature of Broker Date DELETE AGENT NAMED ABOVE to (check one or both): BAR MLS Broker Name (please print): Company Name (please print): Signature of Broker Date o I have returned this License to the AREC o Agent going “Inactive” o Agent transferring to another company/going into Referral PAYMENT INFORMATION TOTAL AMOUNT DUE AND PAYABLE WITH THIS APPLICATION: To BAR $ To MLS $ To pay by credit card, please complete the following: q VISA q MasterCard q American Express q Discover Card # Expiration Date CVC Name on card Signature

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Page 1: AGENT CHANGE FORM - birminghamrealtors.comRevised October 2017 AGENT CHANGE FORM Birmingham Association of REALTORS® / Greater Alabama Multiple Listing Service 3501 Independence Drive,

Revised October 2017

AGENT CHANGE FORM Birmingham Association of REALTORS® / Greater Alabama Multiple Listing Service

3501 Independence Drive, Birmingham, AL 35209 Phone: (205) 871-1911 • Fax: (205) 802-6070 • Email: [email protected]

AGENT INFORMATION (This section must be completed for request to be processed):

XXX/XX/ AgentName(Mr./Mrs./Ms.) PreferredName Last4digitsofSSN

RealEstateLicense# EmailAddress(RequiredforAssociationNoticesandMLSUse)

HomeAddress City/State/Zip CountyofResidence

HomePhone(withareacode) CellPhone(withareacode) OfficePhone(withareacode)

CHANGE REQUEST – AGENTSTATUSWILLBEVERIFIEDWITHARECWEBSITEBEFORESTATUSWILLBECHANGED

TRANSFERAGENTNAMEDABOVE:

FROM: TO: CompanyName(pleaseprint) CompanyName(pleaseprint)

ThefollowingTransferFeesmustaccompanythisform:$25PayabletotheBirminghamAssociationofREALTORS®(BAR)$25PayabletotheGreaterAlabamaMultipleListingService(MLS)

SignatureofTransferringAgent Date

BROKER’SCERTIFICATION(Required):IagreethatasalicenseeofmyfirmIamresponsibleforthefinancialobligationsofthismember.IunderstandthatifmyfirmsubscribestotheMLS,allmyagentswhoengagetoanydegreeinresidentialsalesareconsideredactiveinMLSandmustpayMLSdues.Iherebyunconditionallyguaranteepaymentofallfees,dues,finesorotheramountsowedorduefromtheabove-namedagenttotheBARortheMLS.IherebyauthorizeMLStoreceivelistingscontaininglockboxesfromthesalesassociatenamedaboveandcertifythatIhaveexplainedtothemtheresponsibilitiesandpotentialliabilitiesoflockboxuse.IalsoagreetopaytheattorneyfeescourtcostsandotherlegalexpensesofBARorMLSintheeventeitheremploysanattorneyorinitiateslegalproceedings,tocollectfrommeanyamountsthatIhaveguaranteedhereinandthatarepastdue.

BrokerName(pleaseprint): CompanyName(pleaseprint):

SignatureofBroker Date

DELETEAGENTNAMEDABOVEto(checkoneorboth): BAR MLS

BrokerName(pleaseprint): CompanyName(pleaseprint):

SignatureofBroker Date

oIhavereturnedthisLicensetotheAREC oAgentgoing“Inactive” oAgenttransferringtoanothercompany/goingintoReferral

PAYMENT INFORMATION TOTALAMOUNTDUEANDPAYABLEWITHTHISAPPLICATION: ToBAR$ ToMLS$

Topaybycreditcard,pleasecompletethefollowing:qVISAqMasterCardqAmericanExpressqDiscoverCard# ExpirationDate CVC

Nameoncard Signature

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