Broker MLS Only Application Form

Personal Information:

Home Address:*
Primary Phone:*
Date of Birth:*

License Information:

Name as it appears on TREC License:*
TREC License #:*
Expiration Date:*
License Type:*
Do you hold, or have you ever held a Real Estate License in another State?:*
If “yes,” specify the place(s) and date(s) of such action, and detail the circumstances relating there to:
Are there now any pending or unresolved complaints, or have there been within the past 3 years, any complaints against you or the firm with which you have been associated before any state real estate regulatory agency or any other agency of government?:*
If "yes", specify the substance of each complaint in each state, the agency before which complaint was made, and the current status or resolution of such complaint:

Company Information:

Office Name:*
Office Address:

Primary Association Information:

Please specify your current primary board or association** (Additional Documentation Required for MLS Only Memberships: Letter of Good Standing from agent’s primary board or association.):*

Supra Options (For MLS Members):

Do you already have a Supra Key with another board or association that you would like to co-op? *
If “yes,” please provide Key Serial Number and 4-digit pin:
Would you like to get a Supra eKey? *
If “yes,” please choose a 4-digit pin:

MLS Aggreement:

(1) We have read the Rules and Regulations governing the MLS.

(2) We agree to comply with the Rules and Regulations as they may be amended from time to time.

(3) We confirm that we are currently, and will on a continual and ongoing basis in the operation of our real estate business activities, actively endeavor to list real property of the type filed with the MLS and/or accept offers of cooperation and compensation made by other Participants through the MLS.

(4) We understand that CCAR will attempt to, but is not obligated to, give us notice if the Rules and Regulations are amended from time and that we can access a current copy of the Rules and Regulations either on the MLS web site, CCAR’s web site, or by requesting a copy from CCAR.

(5) We agree to pay all fees, in advance, for access and use of the MLS. We understand that those fees may change from time to time without advance notice. As of the date this agreement is signed the fees for access to the MLS are as shown on the attached Fee Exhibit.

(6) We understand that we may be required to agree to a license agreement with the vendor who provides the software and programs to CCAR for use with its MLS. We represent that we will comply with the terms of any such agreement when accessing the MLS.

(7) We understand that the resolution of any dispute is governed by the Rules and Regulations.

(8) We will not permit anyone who is not a Participant or subscriber to access or use the MLS or the MLS information, except as permitted by the Rules and Regulations.

(9) If any of the undersigned subscribers cease to be affiliated with the Participant as employees or

independent contractors, the Participant and subscriber will promptly notify CCAR. We understand that a subscriber may not access or use the MLS independently of a Participant.

(10) All fees, once paid, are not prorated and are not refundable.

(11) As the undersigned Participant, I am responsible for the actions of all subscribers who are affiliated with me. I will take necessary steps so that subscribers affiliated with me will comply with the Rules and Regulations. I will be responsible to CCAR for the payment of all fees, charges, and fines assessed against me and the subscribers affiliated with me.

I hereby certify that the foregoing information furnished by me is true and correct, and I agree that failure to provide complete and accurate information as requested, or any misstatement of fact, may be grounds for revocation of my membership, if granted. 

Broker Signature: (Please type your name)*
Word Verification: