Change in Subscriber Information
Print this completed form, sign, and FAX it to HIS at 888-628-3121 or 536-6499
(Or mail it to us, if you prefer)

CHANGE IN SUBSCRIBER INFORMATION

Date:______________ Subscriber Last Name: First Name: User ID#: Office Phone: Home Phone:     Office/Company Transfer Attach Real Estate Commission notification form (If transfer of listings is involved, please attach an Application to Transfer Listings form)          Previous Firm Name:____________________________________Broker Code:_______          New Firm Name:_______________________________________Broker Code:_______          Branch Address:_________________________________City:_________Zip:________          Branch Phone:________________________Branch fax:_________________________   Local Association Affiliation Change The above named Subscriber has changed local REALTOR® Association/Board Affiliation          Previous Association: _____________________ New Association: ______________________ The above-named Subscriber has terminated all REALTOR Association/Board Affiliation.     This action may result in higher monthly HIS subscription fees for the Subscriber’s next billing.    Subscriber Contact Information Change    Name Change: Please attach a copy of the real estate license/appraiser certificate showing          new name                      New Name: ___________________________________ Nickname: __________________    New Home Address: ______________________________________________________________    New Phone/Voice Mail/e-mail information:            Home:_________________________________Home fax:_______________________________            Pager:_________________________________Cell:____________________________________            Voice Mail:_____________________________E-mail:__________________________________            Agent office:___________________________Agent office fax:___________________________    Termination of HIS Subscription – BROKER SIGNATURE REQUIRED    Please terminate my HIS subscription effective the following business day          Check applicable box below    The above named subscriber has returned their license to the Real Estate Commission    The above-named subscriber has transferred to secretary/assistant/waiver status.          Waiver application granted by HIS on _________________ Broker or BIC’s signature: ___________________________________________________________                                                            (Required for processing)                  Subscriber ID#   Print this completed form, sign, and FAX it to HIS at 888-628-3121 or 536-6499 (Or mail it to us, if you prefer)

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