Broker Accreditation Application Form

Broker Accreditation Application Form and Accreditation Agreement

Application Date:

Recitals

WHEREAS, Applicant seeks accreditation from the Accrediting Body by demonstrating compliance with the qualification standards and operational practices required for accredited brokers; and

WHEREAS, Accrediting Body evaluates applicants, grants accreditation subject to payment of fees and acceptance of terms, and monitors ongoing compliance; and

WHEREAS, the parties desire to record herein the application information and the terms pursuant to which accreditation will be granted, maintained, or terminated.

Applicant Information

Individual   Corporation   LLC   Partnership

Accreditation Details

Accreditation Category (select applicable):

Residential Brokerage   Commercial Brokerage   Mortgage Brokerage   Insurance Brokerage   Other

Scope of Work

Describe the scope of activities, services, and market areas for which accreditation is sought. This description will form part of the limits of accreditation if granted.

Payment Terms

Applicant agrees to pay the accreditation fee in accordance with the schedule below as a condition precedent to issuance of accreditation.

Payment Schedule: One-time on approval Annual renewal Quarterly

Late Payment: A late fee of will apply to overdue amounts, compounded monthly, together with collection costs and attorneys' fees incurred to enforce payment.

Term and Termination

Term Commencement Date:    Term Expiration Date:

Either party may terminate accreditation for material breach, insolvency, or failure to pay fees. Except in cases of material breach, termination by either party requires written notice delivered not less than days prior to the effective date of termination.

Confidentiality

Each party shall keep confidential all non-public information disclosed by the other party that is designated confidential or that a reasonable person would understand to be confidential, including business methods, client lists, pricing, and audit materials ("Confidential Information"). Confidential Information shall not include information that is publicly known, rightfully received from a third party without restriction, or independently developed. Confidential Information shall be used solely for purposes of the accreditation relationship. The receiving party shall implement reasonable safeguards to protect Confidential Information and shall return or destroy such information upon termination or upon request.

Certifications, Representations and Declarations

The Applicant certifies, represents, and warrants under penalty of perjury that the information supplied in this Application is true, correct, and complete to the best of Applicant's knowledge and that Applicant will promptly notify Accrediting Body in writing of any material change.

Applicant authorizes Accrediting Body to verify representations, contact references, and obtain public records and licensing history as reasonably necessary to evaluate this application.

Applicant must indicate acceptance of the following attestations:

Applicant complies with applicable licensing laws, regulations, and professional standards.
No undisclosed material judgments, liens, or disciplinary actions affect Applicant.
All information provided is accurate and may be relied upon by Accrediting Body.

References and Supporting Documentation

Required attachments (check those attached):

Copy of broker license   Certificate of insurance   Recent financial statement   Consent to background check

Governing Law

This Agreement and any dispute arising out of it shall be governed by and construed in accordance with the laws of the state of , without regard to conflicts of law principles.

Entire Agreement

This Application and Accreditation Agreement, including all attachments, exhibits, and approved scope statements, constitutes the entire agreement between Applicant and Accrediting Body with respect to accreditation and supersedes all prior negotiations, understandings, and agreements, whether written or oral. Any amendment must be in writing and signed by both parties.

Acknowledgment and Authorization

By signing below, Applicant affirms the truth of all statements made herein, agrees to be bound by the terms and conditions of accreditation set forth in this Agreement, and authorizes Accrediting Body to take such actions as are reasonably necessary to verify information and enforce compliance.

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