400 Club Member Information Form

All Members must complete this form, provide a valid copy of their Drivers License, Real Estate License and Board of Realtors Membership Card. If you are not a member of the Real Estate Board and MLS, you must complete the Non Realtor Independent Contractors Agreement in order to keep you license active.

Click the links on the left hand side of this page and complete a W-9, Sign our independent Contractors Agreement and email copies of your Identifications to Broker James at Arenastatellc@gmail.com.

2023 Member Information

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Home Address

Birthdate Date

YYYY

Social Security Number

Drivers License Number

Real Estate License Number

MLS Identification number

Direct Pay Information

Name of Bank

Account Number

Routing Number

1099 Employee Tax Information

How Will You Be Paid

If you are being paid as a company you will need to provide your companies address and TIN number.

Company TIN

This is only needed if you are being paid as a company and not as an individual.

Company Address

This is only needed if you are being paid as a company and not as an individual.

Your Website Domain Name