Full Name *

Licensee/Registration Status Select all licenses and registrations you hold: *

Please describe other licenses or registrations pertaining to the above:

Email *

Phone *

Your Organization (Brokerage/Firm/Etc) *

Ratified Representation Agreement Type *

If other please describe type of Ratified Representation Agreement:

List all parties your represent in the above noted agreement; by name and if any organization, by organizaion name: and any notes for about the inquiry or parties; *

Properties or Opportunities you would like to discuss for the specified parties you represent:

If a signed agreement is in place; What is the Expiration Date of the Representation Agreement

By checking this box, I consent to receive non-marketing text messages from [BUSINESS NAME] about [USE_CASE_FROM_CAMPAIGN_DESCRIPTION]. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others, from [BUSINESS NAME] at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

I certified the above is correct and complete and understand that the information is being relied upon by the CREBB Group and/or eXp Commercial and/or their represented parties for the business transaction(s) contemplated in this submission. Furthermore, I understand a separate registration is necessary for each representation agreement and that no information shared with me or my parties is to be aggregated, transmitted, or shared with parties which are not listed on this document: *

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