Duplin-Sampson Association of Realtors

Apply for Duplin-Sampson County Association of Realtors Membership

Date of Application   
Name as shown on License   
Gender    Male      Female    
Name you would like to appear on roster:   
Date of Birth:   
Password: (2-6 numbers or letters)   
Name and Address of Firm: (Please include Firm's Name, Address, City, State and Zip)   
Home Address: (Please include Home Address, City, State and Zip)   
Telephone Numbers: (Include Home Phone, Home FAX and Mobile Phone)   
Contact Phone: (Where you can be reached 99% of the time)   
Email   
Web Site: (If available)   
License Number:   
Type of License: Broker
Salesman
Licensed Appraiser
Certified Appraiser
Registered Trainee
Other
  
If Other, Please Specify   
Position With Firm: Principal
Partner
Corporate Officer
Employee
Officer BIC (Broker In Charge)
Branch BIC (Broker In Charge)
Independent Contractor
  
Are you a member of any other real estate Board/Association, whether or not afiliated with the National Association Of Realtors?    Yes      No    
If yes, name each Association, type of membership, and length of time you were a member:   
Do you intend to hold primary membership with DSAR?    Yes      No    
If you are a member of another Association, what is your NAT/NRDS number?   
If transferring from another Association, have you taken the mandated Code of Ethics Class?    Yes      No    
Do you have any sanctions pending from any other Board/Association? If yes, please email information to jecarr@butlerfairclothrealtors.com    Yes      No