Medlock Realty

    AGENT PROFILE

    EMERGENCY CONTACT

    Licensing Information

    (Only provide your license information for the states you are joining Medlock Realty in.)

    What is the MLS / Associations you will need to join/transfer on:

    Information for Your Profile on Our Website

    Form W-9
    Request for Taxpayer
    Identification Number and Certification

    3.Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes

    Exempt payee code (if any)
    Exemption from FATCA reporting code (if any)





    Social security number
    or
    Employer identification number

    INDEPENDENT CONTRACTOR AGREEMENT
    This Independent Contractor Agreement ("Agreement") is entered into by and between
    MEDLOCK REALTY LLC ("Broker") and (“Agent“)

    Agent singnature

    Date

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