Name *
E-mail Address *
Office *
Broker *
Office Address, City, Zip Code *
Office Telephone Number *
Office Fax Number *
Agent's Cell Phone Number *
Agent's Website *
Individual or Team? Check One *
List Team Members (note Licensed or Not)
Issue Award Certificate in (Name Preferred) *
Designations in the Real Estate Industry (GRI, etc)
CIVIC GROUPS or VOLUNTEER ORGANIZATIONS (NON Real Estate) of which you are CURRENTLY a member
OFFICES or COMMITTEE Involvement in Above Organizations
REAL ESTATE RELATED ORGANIZATIONS of which you are CURRENTLY a member
OFFICES or COMMITTEE involvement in above REAL ESTATE organizations
AWARDS/HONORS won (other than "in-house") in past 2 years
Please List (up to 3) TITLE COMPANIES you primarily use
Please list (up to 3) MORTGAGE COMPANIES you primarily use
Please list (up to 3) NEW Home Builders that you recommend - $300,000 and up
Please List (up to 3) NEW Home Builders that you recommend - under $300,000.
List (up to 3) NEW HOME DEVELOPMENTS/SUBDIVISIONS/COMMUNITIES that you feel best represents your clientele
List any Builders, Developers, Mortgage/Banks or Title Companies that you would like to see as a Sponsor for PT50
Propose a Sponsor or "Type of" Company/Organization that you would like to see working with PT50
PRINT COPY OF YOUR ENTRY FORM BEFORE SUBMITTING!!! Do not exit form until Immediate confirmation (after you "submit") has been received. If Confirmation IS NOT RECEIVED, Call Amber at 210-391-6393

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Fax: 210-349-8767, Email: Amber@PlatinumTop50.com

Questions: Call Amber at 210-391-6393

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     Christina O’Connor

     Senior Loan Officer

          210-414-7534