Hawaii Information Service
Subscriber Information Form - (Exhibit A)
Print this completed form, sign, and FAX it, along with Exhibit C and a
copy of your license to HIS at 888-628-3121 or 536-6499
(Or mail it to us, if you prefer)

SUBSCRIBER INFORMATION FORM - (EXHIBIT A)
Select one Subscription Type

                                          (please print Agent's name if Personal Assistant)
Name: Nick:
                   First Name      Middle        Last Name
Agent ID: Office ID:

INFORMATION BELOW WILL REMAIN CONFIDENTIAL:

Home Address: City: Zip:
Date of Birth: Soc. Sec. Number:

INFORMATION BELOW WILL APPEAR WHERE EVER POSSIBLE:

Car Phone: Pager: Voice Mail:
Home Phone: Home Fax:
E-mail: URL:
Name of Company: Broker :
Office Address: City: Zip :
Office Phone: Office fax:
Agent Office Phone : Agent Office Fax :

I would like my mail to go to my office address Yes No
I would like my home phone number kept confidential Yes No
I have my own computer/Macintosh Yes No
(If yes, please fill out the enclosed Equipment Inventory form)

Request training class for
Morning Afternoon Weekend
My preferred training location:
My primary association/board is
Please attach a copy of your real estate license and/or your appraiser certification.
Please check here if you have a disability which requires special services during the 2-hour training classes:
Visually impaired
Hearing impaired
Wheelchair access
Other (Please describe)
____________________________
____________________________
____________________________
____________________________

For HIS use only: Subscriber # Broker ID

 

Please fax this Exhibit A along with Exhibit C of the Subscription Agreement and a copy of your license to: 1-888-628-3121. (Or mail it to us, if you prefer.)

Forms and Documents | Agreements and Application Forms | Site Index | Home

Copyright © 1998-1999 by MLS Hawaii, Inc. dba Hawaii Information Service. All Rights Reserved.