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Info@BestChoice.us
630-929-1100
1733 Park Street, Suite 150
Naperville, IL 60563

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CRR Agent Records Data Input
First Name
(required)
Last Name
(required)
Preferred Name or Nick Name
License Type
(required)
RE License Number (Insert full number, ie 476.---). Type Pending if newly licensed.
(required)
Your Preferred Phone Number
(required)
Email address:
(required)
Realtor Association Membership (Click on Your Answer)
(required)
Aurora Tri-County (ATCAR)
Chicago (CAR)
Fox Valley (RAFV)
Main Street (MORe, formerly RWSSC)
North Shore-Barrington (NSBAR)
NW Suburban (RANWC)
Three Rivers
None (To join)
MLS ID # (State none if the case)
(required)
County of Residence
(required)
Previous Brokerage Company
(required)
Primary Product Type
(required)
Please List Any Language Spoken Other Than English
(required)
Home Address 1
(required)
Home Address 2
City
(required)
State
(required)
Zip Code
(required)
Home telephone
Cell Phone
Fax Number
Your Gender
(required)
Your Website URL, if any
Emergency Contact
(required)
Phone Number
Relationship (Type spouse, sister, son, partner, etc.)
Street Address
City, State and ZIP
Plan: Type Silver or Gold . (Silver is $35/mo, Gold is $100/mo)
(required)
Birthdate (MM/DD/YY, i.e. 01/20/78)
(required)
Date Joining CRR (i.e. 07/15/2006)
(required)
Are you working real estate full time?
(required) 		Yes
No
If real estate is not full time, what is your primary occupation?
How Did You Hear About Charles Rutenberg Realty?
(required) 		Mailing/Flyer
Referral
Email
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Internet Search
Rejoining
If Referred, What is the Name of the Person Who Referred you? (Please type in first and last name)
(required)
Group (For Office Use Only)
(required)