Application for Membership to NWIBA


Notice

By completing and submitting this application on behalf of your real estate company, you do hereby apply for membership to the Northwest Independent Brokers Association (NWIBA). Membership in the NWIBA is by sponsored invitation and is subject to election and approval by the NWIBA Board of Directors.
In the event of your acceptance to the NWIBA, you agree to abide by the bylaws, rules, and regulations of the NWIBA and to be an active participant in helping to strengthen the organization and each of its members. Please be aware that membership dues are payable on the first of every month and that membership may be canceled by yourself or the NWIBA by written notice, with no refund of monies paid or owing.
If you would rather download, print and fax or mail a paper application to the NWIBA, including a Credit Card authorization form, please Click Here.


Applicant's Name:

 
Real Estate Company:  
Address:  
City:  
State:
Zip:  
Contact Phone:  
Contact Email:    
Number of Offices:  
Number of Licensees:  
Areas of Specialization (by percent): Residential    Commercial    Property Management  
Please List Real Estate Affliations/Designations:
Monthly Rate Based on Number of Licensees:

Credit Card Type:

Credit Card Number:
V/CVC Code:
Expiration Date:
Name on Card:
Billing Address:
Billing City:
Billing State:
Billing ZIP Code:
   
By checking this box and submitting this application for membership I certify that the provided information is true and correct to the best of my knowledge and that I am authorized to represent the above named company. I authorize Northwest Independent Brokers Association to use the information provided in this application for the purposes of verification and consideration for membership. Northwest Independent Brokers Association is authorized to contact me using the contact information I have provided with this application. If providing billing credit card information I authorize Northwest Independent Brokers Association to use the provided credit card information for monthly payment of dues.

This application is sent over a secure connection using SSL to encrypt the information provided. To ensure that this connection is secure please verify that there is a padlock icon in the address bar of your browser and that the "Secured by GeoTrust" icon is in the footer of this website before submitting the application.
      
Check the Acknowledgement Box to Submit Application