Greater Southern MLS - Application

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Personal Information		Business Information		Appraisers		Managing Broker/Broker In Charge		Demographics		Signature Page

Personal Information
Name
N/A

Required First Name Middle Name Required Last Name

As appears on your Real Estate License
Home Address
N/A

Required
Street Address Required City Required State/Region/Province Required
Postal / Zip Code
Louisiana Real Estate License # *
N/A
Real Estate License Type *
N/A
Home Phone
N/A
Mobile Phone *
N/A
N/A

Agreement to Receive Text Messages Agreement to Receive Text Messages

By selecting this box, you agree to receive text messages from Greater Southern MLS.
Business Email *
N/A

This will be the primary email used for communications and with the creation of your log in credentials.
Personal Email *
N/A

This email will be used in the case your business email address no longer works.
Upload a copy of your driver's license. *
N/A
Upload file

Brokerage Information
Brokerage Full Name *
N/A

No abbv.
Brokerage License # *
N/A
Brokerage Phone Number *
N/A
Have you or your firm been found in violation of state real estate licensing regulations within the last year? *
N/A
Have you or you firm been convicted, adjudged, or otherwise recorded as guilty? *
N/A
Do you hold, or have you ever held, a real estate license in any other state?
N/A

List the States in which you are licensed.
Qualifying Broker/Broker in Charge Information
Qualifying Broker/Broker in Charge Name *
N/A

Provide full name.
Qualifying Broker/Broker in Charge License # *
N/A
Qualifying Broker/Broker in Change Email *
N/A
Office Information
Real Estate Office/Branch *
N/A

Provide full name, not abbv.
Office License # *
N/A
Office Email *
N/A
Office Phone Number
N/A
Office Address
N/A

Required
Street Address
Address Line 2 Required City Required State/Region/Province Required
Postal / Zip Code
Branch/Office Broker's Full Name
N/A

Compliance Email Address
N/A

For any compliance notices this will be one of the email addresses used, other than the BIC's email address.

Demographics

This section is completely optional.
Which other MLSs do you belong to?
N/A

If you do not belong to any other MLSs, please skip.
Which of the following designations do you have?
N/A

If you do not have any designations, please skip
Agent/Appraiser website
N/A

Subscription Type *
N/A

Greater Southern MLS offered several payment choices. Please select the frequency of payment. Please note, there will also be a 1 time setup fee and an annual security fee. Note: Payment is Non-Refundable
Upon receipt of this application, Greater Southern MLS will review all details submitted. If there are any questions related to this application, someone from Greater Southern MLS will reach out to you for clarification.

If Greater Southern MLS needs no additional information, we will send you an invoice to pay for set up fee and the subscription fee - billed separately.

By signing below, you agree with the following:
- To read and agree to the Greater Southern MLS rules and regulations
- To read and agree to the Greater Southern MLS EULA
- To read and agree to the Greater Southern MLS Citation Policy
Signature *
N/A

E-Signature Field
Clear
Verification Code *
Enter the text in the box below

Personal Information