Fillable AFFILIATE KEY APPLICATION (Salt Lake Board of Realtors)

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AFFILIATE KEY APPLICATION (Salt Lake Board of Realtors)

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230 W. TOWNE RIDGE PARKWAY, STE. 100, SANDY, UTAH 84070 | PHONE: 801-542-8840 | EMAIL: ASSISTANT@SLREALTORS.COM AFFILIATE KEY APPLICATION
AFFILIATE KEY APPLICATION
INSTRUCTIONS
1. Please download, fill, save, and electronically submit this application to assistant@slrealtors.com.
2. Once your application is received, we will reach out to you by phone or email with a quote for dues and payment instructions.
3. After dues are paid, we will send you a welcome email with important membership information. Please read it in its entirety.
To receive a Supra eKEY, you must complete this application in its entirety. Access to the Supra system is conditioned upon:
• The
contents of this application
• Completion of the Board’s Code of Ethics course
• Proof of liability insurance
• A criminal background check
PLEASE SELECT YOUR BUSINESS TYPE
HOME INSPECTOR OTHER: __________________________________________________________________________________________________________
SECTION 1 AFFILIATE INFORMATION
ARE YOU CURRENTLY A MEMBER OF ANOTHER REALTOR® ORGANIZATION? YES NO
(IF YES) PRIMARY REALTOR® ASSOCIATION NAME: ____________________________________________________________________________________
NATIONAL REALTOR® (NRDS) #: ________________________________
SECTION 2
PERSONAL INFORMATION
FIRST NAME: ____________________________ MIDDLE NAME: ____________________________ LAST NAME: __________________________________
PHONE: ____________________________________________ HOME CELL WORK OTHER
EMAIL ADDRESS: _____________________________________________________________ BIRTHDATE: _______________________________________
HOME ADDRESS: _______________________________________________________________________________________________________________
CITY: ________________________________________ STATE: ____________________________ ZIP: _________________________________
LANGUAGES SPOKEN:
ENGLISH SPANISH MANDARIN OTHER ___________________
VETERAN: YES NO
GENDER: MALE FEMALE NON-BINARY
SECTION 3
COMPANY INFORMATION
COMPANY NAME: ______________________________________________________________________________________________________________
COMPANY PHONE: ____________________________________________ HOME CELL WORK OTHER
COMPANY ADDRESS: ____________________________________________________________________________________________________________
CITY: ________________________________________ STATE: ____________________________ ZIP: __________________________________
TITLE OR POSITION: ______________________________________________________________________________________________________________
230 W. TOWNE RIDGE PARKWAY, STE. 100, SANDY, UTAH 84070 | PHONE: 801-542-8840 | EMAIL: ASSISTANT@SLREALTORS.COM AFFILIATE KEY APPLICATION
SECTION 4 LEGAL ACTIONS
Check the appropriate box, as each statement applies to you:
If you answer "YES" to any of the questions below, you must provide a written explanation on a separate page and attach it to this application.
YES NO
1. Do you have knowledge of any complaint(s), investigation(s), or disciplinary action(s) currently ongoing or pending against you by a
regulatory or licensing body?
2. Have you ever been convicted of or plead “guilty” or “nolo contendere” to a felony, Class A or B misdemeanor, or comparable criminal
offense? A traffic violation can be prosecuted as a felony, Class A or B misdemeanor, or comparable criminal offense. Disclosure is required
if you have this kind of traffic violation on your record.
3. Have you ever resolved a felony, Class A or B misdemeanor, or comparable criminal offense (including traffic violations prosecuted as such)
through a plea in abeyance, diversion agreement, withheld judgment, or other method whereby a charge was held in suspense during a
period of time in which you were on probation or were obligated to comply with conditions outlined by a court?
4. Are you aware of any investigation(s), indictment(s), or criminal charge(s) which are currently pending against you for any crime in any
jurisdiction?
5. Have you ever been subject to court martial or dishonorable discharge from any branch of the armed services?
6. Have you ever been required to register as a sex offender?
7. Have you ever had a judgment entered against you in a civil or bankruptcy court on the basis of fraud, misrepresentation, or deceit?
8. Have you ever been found in contempt of court?
SECTION 5
CITIZENSHIP
I certify under penalty of perjury that (check the appropriate box and enter the requested data):
I AM A CITIZEN OF THE UNITED STATES WITH A SOCIAL SECURITY NUMBER SS# _____________________________________________________
I AM A QUALIFIED ALIEN UNDER 8 U.S.C 1641 AND CAN PROVIDE EITHER AN I-94 OR ALIEN #.
*Attach a copy (front & back) of I-94 OR Alien # Card to this application
I-94 ______________________________________ ALIEN # ______________________________________
SECTION 6
IDENTIFICATION
I certify under penalty that I am legally present in the United States and that (check the appropriate box and enter the requested data):
I HAVE A VALID DRIVER LICENSE
I HAVE A VALID STATE IDENTIFICATION CARD
LICENSE # ____________________________________________________________
STATE OF ISSUE ________________________________________________________
CARD # _______________________________________________________________
STATE OF ISSUE _________________________________________________________
SECTION 7 PROOF OF INSURANCE
By signing this document, I certify that I have a general liability insurance policy with a minimum of $1 million of coverage, in accordance with Utah law.
I HAVE ATTACHED PROOF OF MY INSURANCE POLICY TO THIS APPLICATION
I AGREE TO SEND THE BOARD PROOF OF INSURANCE RENEWAL AND/OR CHANGES UPON CURRENT POLICY EXPIRATION
230 W. TOWNE RIDGE PARKWAY, STE. 100, SANDY, UTAH 84070 | PHONE: 801-542-8840 | EMAIL: ASSISTANT@SLREALTORS.COM AFFILIATE KEY APPLICATION
MEMBERSHIP AGREEMENT
If my application is approved, I, the undersigned, agree to the following (please initial each box):
I hereby certify that I have read and understood this document, and that the information I have provided is true and accurate.
I certify that I am at least 18 years of age and have a minimum of a high school diploma or its equivalent.
I understand that the primary form of communication for the Salt Lake Board of Realtors® is email. I agree to check my email often so that I don’t
miss important Board communications, and will promptly notify the Board of any changes to my email address or other contact information.
I agree to become familiar with the Code of Ethics, as well as the bylaws of the Salt Lake Board of Realtors®, which can be found on the Board website.
I will also familiarize myself with the rules and regulations of the Utah Association of Realtors®. The annual renewal of my membership shall
indicate my continued commitment to abide by the aforementioned standards as they are amended from time to time.
I further consent that the Board may request information and comment about me from any Board member or other persons. I accept that
any response (from any person) furnished to the Board in such an event shall be conclusively deemed to be privileged and not form the basis of any
action for slander, libel, or defamation of character.
I understand and agree that I will act in accordance to the Key Agreement I will sign upon receiving a Supra eKEY; namely that I will only use said key
to gain access to properties for which I have been contracted to provide services and have permission to enter. I agree to confirm
appointments before entering any property.
I agree to pay my annual renewal dues each June, in the amount specified to me by the Board. I understand that dues are subject to review and
possible change annually. I recognize that dues are non-refundable, and that once paid, they become the property of the Board. If I do not renew,
or my membership is terminated, I will immediately cease to represent myself as being affiliated with a Realtor® association.
I acknowledge that at least one member of my company must maintain an active Affiliate membership in order for me to avoid paying a $200 re-
entry fee, should I discontinue my membership and rejoin at a later date. If there are no active Affiliate members in my company when I rejoin, I agree
to pay the re-entry fee.
I consent that the Salt Lake, Utah, and National Association of Realtors® and their subsidiaries, may contact me using the information provided
on this form, or by other available means of communication. This consent extends to possible future changes in contact information. I waive any
limits placed on communication by certain state/federal laws in order to receive all membership communications.
REQUIRED BACKGROUND CHECK
STEPS TO COMPLETE ONLINE BACKGROUND CHECK
1. Upon submission of this form, the Board will send you a welcome email with a link to Spectrum Security Group’s online background check.
2. Pay $15 to Spectrum Security Group and complete the online background check.
APPLICANT SIGNATURE: ____________________________________________________________ DATE: _________________________
In connection with my application for access to the Supra key and lockbox system, I hereby agree to obtain and furnish for review the results of
the background check. I understand that this report will provide details of the criminal background check, in order to ascertain any and all
information which may be relevant and pertinent to being approved for access to the Supra system. If the report shows that I have failed to
accurately disclose my criminal history or that I have a criminal record, I understand that access to the Supra system may be withheld or
revoked, in accordance with Board policies.
After the completion of the above background check, I agree to notify the Board within ten (10) days in the possible future event that I am
convicted of, or plead “guilty” or “nolo contendere” to a felony, Class A or B misdemeanor, or comparable criminal offense (including traffic
violations prosecuted as such), or any other conviction that reflects poorly on my character. I understand that access to the Supra system may
be withheld or revoked in accordance with Board policies.
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AFFILIATE KEY APPLICATION (Salt Lake Board of Realtors)

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Completed 16 June 2022

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