PRC Network
 
 
Type of Membership : Individual Team Office Limited
*Legal Name in which PRC Membership is to be held:
Community Requested: *Name *Zip Code
 
REALTOR® INFORMATION (Please type or print clearly. Use black ink.)
*Last Name *First Name M.I.
*User Name *Password *Confirm Password
*Home Address *City
*State  
Zip
Home Phone *Business Phone
e.g. 123-456-7890
*Cell Phone
e.g. 123-456-7890		 Fax
*Email Address
Personal Website Address (if applicable)
*Real Estate License #
*Year Licensed
Name Of Board Affiliation
Phone Number
*# Of Years as a Resident
Estimated Annual Gross Commission Income
Company Name
Designation    
Company Address
City
State
*Zip
Supervising Broker Name
Phone Number
Do you have a Business Partner? Yes No
Do you have a Team? Yes No
If Yes, What is His/Her Name?
If Yes, How many Members?
What is your Team Name?
1) Are you licensed under or have you practiced under any other name? Yes No
2) Has your license ever been denied or revoked? Yes No
3) Have you ever been convicted of a felony? Yes No
4) Have you ever been subject to peer review or any disciplinary action (ie: probation, suspension)? Yes No
5) Have you ever had any complaints filed against you with the state licensing board? Yes No
6) Have you or has any entity controlled by you ever been sued for Negligence or Fraud? Yes No
7) Has any E&O Carrier paid money to defend or settle damages as a result of a claim against you? Yes No
8) Please provide a written and signed explanation for all ‘YES’ answers above, including: Date, Case Number,Reasons and Outcome of Action. Is there an attachment of explanation? Yes No
 
AUTHORIZATION
 

I understand that the PRC Brand is 100% dependent upon PRC having the ability to verify my credentials to consumers. I affirm that the information I have provided herein is correct. I understand that my initial PRC Membership Approval is CONDITIONAL until I provide PRC with

  1. Three (3) Years Proof of Licensure,
  2. Three (3) Years Proof of Membership with NAR,
  3. Three (3) Years Proof of Residence,
  4. Supervising Broker Letter,
  5. Three (3) Client Letters which will include how I specifically made a difference in their real estate sale or purchase. I will provide these items to PRC within 30 days of joining.
  6. If requested, I will sign a 3-party release to complete my background check.
  7. I understand that ALL INFORMATION provided and collected will NOT be shared with anyone outside of PRC.
 
I understand that any false statements, representations or failure to provide PRC information requested herein may jeopardize my permanent annual membership and forfeiture of any and all fees paid or owed to PRC. I understand that PRC will begin the process of ‘on boarding’ me within three (3) business days of joining and that my PRC Membership Fee is fully earned at the time I join PRC. Prior to signing this Application, I have read and AGREE to the PRC Member Terms of Use found at the bottom of the www.PRCStandards.net homepage. I agree to indemnify and Hold PRC and/or its affiliates Harmless from any claims and/or damages arising as a result of any information I have provided herein found to be inaccurate, false or misleading.
 
 
Enter the Text in the Image in the box given Right
 
 

PRC Network - 4533 MacArthur Blvd. Suite 100 Newport Beach, CA 92660
Copyright 2008 - All Rights Reserved