BROKER RECIPROCITY AGENT AUTHORIZATION FORM

I hereby authorize the agent listed below to display the Broker Reciprocity (BR) database on his/her website. I understand that I must be a Broker Reciprocity Subscriber (BRS) for this agent to do so.

As a BRS, the agent agrees to follow all BR rules and policies. If they fail to pay any related fees their BR listings must be promptly removed from their site.*

This form must be filled out completely and signed by the MLS Participant for your office. Once it has been filled out and
signed, fax it to MLS Customer Service at 631-661-4589.

Firm Name___________________________________________________________

Address______________________________________________________________

Town_______________________________ Phone_________________________

Licensed Agent Name (Print) ____________________________________________

Licensed Agent Signature _______________________________________________

Member# ____________________________

MLS Participant (Print)_________________________________________________

MLS Participant Signature______________________________________________

Date_____________________

* The MLS Participant will not be held liable for these fees incurred by the agent.