Common use of STATEMENT OF APPLICANT Clause in Contracts

STATEMENT OF APPLICANT. The Keyholder states that all the information which is provided in this Application/Agreement is true in every respect, and understand that any false, misleading or forged statement made in this document or in connection with this application, or failure to provide relevant information, may be grounds for denial of the application and/or revocation of any Service access or other privileges granted to me. KEYHOLDER/Applicant: (Print name) (Signature) Date Keyholder’s email Xxxxxxxxx’s preferred phone number MLS Company Name Registered with MLS (DBA) MLS Firm # Print Name of Authorized Representative of Company Signature of Authorized Representative of Company Date Relationship of Authorized Representative to Company (e.g. Principal Broker, Manager): Company Legal Name (if different from name above): _ Company Address and City Info: KEY Activation Fee $95.00 + Tax: $99.75 (5%) for Winnebago County Firms FOR MLS OFFICE USE: Agent Key # Assigned Date Assigned Check # Amount $ Name on Check: Received Date: $100.23 (5.5%) for ALL other County Firms Charge: (VISA / MasterCard accepted) Card # Exp. Date Amount $ Print Name As Appears On Card Cardholder’s Signature Date Cardholder’s Address

STATEMENT OF APPLICANT. The Keyholder states that all the information which is provided in this Application/Agreement is true in every respect, and understand that any false, misleading or forged statement made in this document or in connection with this application, or failure to provide relevant information, may be grounds for denial of the application and/or revocation of any Service access or other privileges granted to me. KEYHOLDER/Applicant: (Print name) (Signature) Date Keyholder’s email Xxxxxxxxx’s preferred phone number MLS Company Name Registered with MLS (DBA) MLS Firm # Print Name of Authorized Representative of Company Signature of Authorized Representative of Company Date Relationship of Authorized Representative to Company (e.g. Principal Broker, Manager): Company Legal Name (if different from name above): _ Company Address and City Info: KEY Activation Fee $95.00 + Tax: $99.75 (5%) for Outagamie & Winnebago County Firms FOR MLS OFFICE USE: Agent Key # Assigned Date Assigned Check # Amount $ Name on Check: Received Date: $100.23 (5.5%) for ALL other County Firms Charge: (VISA / MasterCard accepted) Card # Exp. Date Amount $ Print Name As Appears On Card Cardholder’s Signature Date Cardholder’s AddressDate

STATEMENT OF APPLICANT. The Keyholder states that all the information which is provided in this Application/Agreement is true in every respect, and understand that any false, misleading or forged statement made in this document or in connection with this application, or failure to provide relevant information, may be grounds for denial of the application and/or revocation of any Service access or other privileges granted to me. KEYHOLDER/Applicant: (Print name) (Signature) Date Keyholder’s email XxxxxxxxxKeyholder’s preferred phone number MLS Company Name Registered with MLS (DBA) MLS Firm # Print Name of Authorized Representative of Company Signature of Authorized Representative of Company Date Relationship of Authorized Representative to Company (e.g. Principal Broker, Manager): Company Legal Name (if different from name above): _ Company Address and City Info: KEY Activation Fee $95.00 + Tax: $99.75 (5%) for Winnebago County Firms FOR MLS OFFICE USE: Agent Key # Assigned Date Assigned Check # Amount $ Name on Check: Received Date: $100.23 (5.5%) for ALL other County Firms Charge: (VISA / MasterCard accepted) Card # Exp. Date Amount $ Print Name As Appears On Card Cardholder’s Signature Date Cardholder’s Address