Heartland Association of REALTORS
North Office
815 US 27 South
Sebring, Fl 33870
Phone: (863) 385-6014
Fax: (863) 385-4944
Monday - Friday
8:30 - 12:30
1:30 - 5:00
Closed Saturday and Sunday
Heartland Association of REALTORS
South Office
124 East Park Street
Lake Placid, Fl 33872
Phone (863)-465-3444
Office Hours
Monday-Friday
8:00 - 4:00
Closed Saturday and Sunday
Contact Us
© 2007 - 2009 Heartland Association of Realtors, All Rights Reserved
Arianna Jordan Burke Lisa LittlesExecutive Director Executive Assistantarianna@heartlandrealtors.org lisa@heartlandrealtors.org
HEARTLAND ASSOCIATION OF REALTORS®, INC.
BROKER/APPRAISER/AGENT APPLICATION FOR MEMBERSHIP
815 US 27 South, Sebring, FL 33870
Phone 863-385-6014~ Fax 863-385-4944
e-mail arianna@heartlandrealtors.org
SECTION 1: LICENSEE
Name as shown on license ______________________________________
License #___________________________
Home Address________________________________________________
City __________________________State _____Zip__________________
e-mail___________________________ Cell phone #_________________
WEB page address _________________________ Fax # __________
To the Heartland Association of REALTORS®, I hereby apply for REALTOR®/Appraiser Membership in the above named Association
and am enclosing my check in the amount of $ 100.00 for a one time application fee and $124.00 (pro-rated monthly) for my Dues,
payable to Heartland Association of REALTORS®, Inc. My application fee and dues will be returned to me in the event of non-election.
In the event of my election, I agree to abide by the Code of Ethics of the National Association of REALTORS®, which includes the duty
to arbitrate,
and the Constitution, Bylaws and Rules and Regulations of the above named Association, the State Association and the National
Association. I understand membership brings certain privileges and obligations that require compliance. I understand that I will be
required to complete periodic Code of Ethics training as specified in the Association’s bylaws as a condition of continued membership.
Signature of Applicant _________________________________________
Date ______________________________
NOTE: Applicant acknowledges that if accepted as a Member and he/she subsequently resigns or is expelled from membership in the
Association with an Ethics Complaint or Arbitration Request pending, the Board of Directors may condition renewal of membership
upon applicant’s verification that he/she will submit to the pending Ethics or Arbitration Proceeding and will abide by the decision of the
Hearing Panel;
or if applicant resigns or is expelled from membership without having complied with an award in Arbitration, the Board of Directors may
condition renewal of membership upon his/her payment of the award, plus any costs that have been established previously as due and
payable in relation thereto, provided that the award and such costs have not, in the interim, been otherwise satisfied.
NOTE: Dues payments to the Heartland Association are not tax deductible as charitable contributions. Portions of such payments
may be tax deductible as ordinary and necessary business expenses.
SECTION 2: LICENSEE
I hereby submit the following information for your consideration:
Name, as you want it to appear on MLS Roster ______________________
Date License Issued ___________________________
Name of Real Estate/Appraisal Firm ______________________________
Office Address _______________________________________________
State position with firm: Principal Partner Corporate Officer
Office Manager Employee Independent Contractor
State whether: Sole Proprietor DBA Partnership Corporation
Password for CTI ____________________(this is for you to determine, and may include letters, numbers or a combination of both)
SECTION 3: LICENSEE
Are there any pending or unresolved complaints, or have there been within the past 5 years, any complaints before any State Real
Estate/Appraisal Regulatory Agency or any other Government Agency?
Yes No
If “Yes” please specify the substance of each complaint, the State complaint was made, the Agency before which the complaint was
made, and the current status or resolution of such complaint.
________________________________________________________________
________________________________________________________________
________________________________________________________________
Have you ever been convicted of a felony or misdemeanor?
Yes No
If Yes” please specify details including the State and Court of Conviction.
________________________________________________________________________________________________________________________________
________________________________________________________________.
Have you had a Real Estate/Appraisal License in Florida or any other state that has expired/ been revoked/ suspended or involuntarily
inactivated?
_______Yes ________No
If “Yes” please specify the Place(s) and Date(s) of such action and detail the circumstances relating thereto.
________________________________________________________________
________________________________________________________________
________________________________________________________________
Do you hold, or have you ever held a real estate license in any other state? Yes No
If “Yes” please specify state. _________________________________________________________
Resident in Highlands County since____________________________
Previous Residence _________________________________________
Are you currently a member of any other real estate Association/Board affiliated with the NATIONAL ASSOCIATION OF REALTORS®? Yes No
Name of Association____________________________________________
Have you/are you participating in another Multiple Listing Service?
Yes No
Name, Where and When?___________________________________________________________
SECTION 4
I HEREBY CERTIFY THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT, AND THAT I AGREE THAT FAILURE TO
PROVIDE COMPLETE AND ACCURATE INFORMATION AS REQUESTED, OR ANY MISSTATEMENTS OF FACT, MAY BE
GROUNDS FOR TERMINATION OF MY MEMBERSHIP IN THE HEARTLAND ASSOCIATION OF REALTORS®, INC.
Signed:__________________________________________Date:____________
Please Print Name Here ________________________________________________
PRORATION OF ASSOCIATION DUES
Association Application and Dues payable to the Heartland Association of REALTORS®, Inc.
Association dues required to join the Heartland Association of REALTORS®, Inc. are composed of three parts: National, State and
Local. If an applicant has belonged to another Association during the current year, they may not owe the NAR and/or FAR dues. If
you are coming from another board and have paid the dues, please provide a letter of Good Standing. Dues are based on the calendar
year.
All figures apply to new applicants only. The pro-ration is based upon the day the applicant makes application, but should be within 30
days of becoming affiliated with a member Broker by licensure with the Florida Real Estate Commission. All fees and dues must
accompany the application in order to be processed.
NEW MEMBER ASSOCIATION FEES:
Local Association Application Fee: (ONE TIME) $ 100.00
Heartland Association of REALTORS®, Inc. (YEARLY DUES) $ 124.00
The Multiple Listing fees will be billed to your Broker on a monthly basis.
The cost is $23.70 per agent per month for unlimited listings and MLS user fees.
Heartland Multiple Listing Service
815 US Hwy 27 South Sebring, Florida 33870
863-385-6014 arianna@heartlandrealtors.org
IF THIS IS A NEW OFFICE, PLEASE COMPLETE THIS APPLICATION FOR BROKER/APPRAISER NEW OFFICE MEMBERSHIP
AS WELL.
Thank you for your inquiry concerning the Heartland Multiple Listing Service.
The Broker of the Real Estate Company is required to become a member. Each licensee under the Broker is required to be a
participant as well. If you are joining as a Branch, kindly send along the occupational license and license from DBPR for that Branch.
There are no exceptions.
Kindly complete the attached application and branch certification and return to this office with your check made payable to Heartland
Multiple Listing Service. Upon receipt, your application will be processed. The DBPR will be contacted to verify each licensee in the
office and packages will be sent to the office for each person, with the By-Laws and Rules and Regulations governing the HMLS.
Included in the package will be program disks and instructions on how to install and use CTI. There is also a web based CTI program
available for your use.
Along with your completed application and check, kindly sign the bottom of this letter and return as well. Once again, thank you for
your interest in our Board and we look forward to being of service to you.
Company information: Sole Proprietor Partnership Corporation LLC(Limited Liability Company)
Office Name:____________________________________________
Office Address:__________________________________________
Office phone # __________________fax# ____________________
Office web page _________________________________________
Your position: Principal Partner Corporate Officer Branch Office Manager
Names of other Partners/Officers of your firm: ________________________________________________________________
Have you ever been refused membership in any other Association of REALTORS®? Yes No
If yes, please state the basis for each such refusal and detail the circumstances related thereto: ________________________________________________________________
________________________________________________________________
Is the Office Address, as stated, your principal place of business?
Yes No
If not, or if you have any branch offices, please indicate and give address: ________________________________________________________________
________________________________________________________________
Have you or your firm been found in violation of state real estate/appraisal licensing regulations within the last three years?
Yes No
If yes, please provide details: ________________________________________________________________
_______________________________________________________________
________________________________________________________________
Have you or you firm been convicted, adjudged, or otherwise recorded as guilty by a final judgment of any court of competent
jurisdiction of a felony or other crime. Yes No
If yes, please provide details: ________________________________________________________________________________________________________________________________
________________________________________________________________
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, shall be grounds for revocation of my membership if granted.
I further agree that, if accepted for membership in the Association, I shall pay the fees and dues as from time to time established.
NOTE: Payments to the Heartland Association of REALTORS® are not deductible as charitable contributions. Such payments may,
however, be deductible as an ordinary and necessary business expense. No refunds.
By signing below I consent that the REALTOR® Associations (local, state, national) and their subsidiaries, if any (e.g., MLS,
Foundation) may contact me at the specified address, telephone numbers, fax numbers, email address or other means of
communication available. This consent applies to changes in contact information that may be provided by me to the Association(s)
in the future. This consent recognizes that certain state and federal laws may place limits on communications that I am waiving to
receive all communications as part of my membership.
MLS NEW OFFICE APPLICATION FEE
ONE TIME $150.00
The Multiple Listing fees will be billed to the Broker or Appraiser on a monthly basis.
The cost is $23.70 per agent per month for unlimited listings and MLS user fees.
Dated: __________________Signature:___________________________
Yours Sincerely,
Arianna Jordan Burke
Executive Director
I have read the conditions concerning membership in the Heartland Multiple Listing Service. The information attached is true and
accurate to the best of my knowledge.
Failure to comply will result in membership being denied.
_______________________________________
Broker
If you wish to become a member of our Association as a REALTOR, Broker or Affiliate, please feel free to call us and to complete and send us the following application. Please scroll down.
