Form | Limited Function Referral Office (LFRO)

To Designated REALTORS®: Please complete all fields on the following form and return to the association office within ten calendar days. A new form must be completed each year.

In accordance with Article IX, Section 2, of the Association’s bylaws, this will certify that the undersigned Designated REALTOR® (or his firm) has a direct or indirect ownership interest in an entity engaged exclusively in soliciting and/or referring clients and customers to the REALTOR® for consideration on a substantially exclusive basis and are not participants or subscribers in any Multiple Listing Service (“MLS”).

This will also certify that all of the licensees affiliated with that entity (list provided below) are solely engaged in referring clients and customers and are not engaged in listing, selling, leasing, renting, managing, counseling, appraising, or arranging financing for real property and are not participants or subscribers in any MLS. (Include additional names on a separate sheet)

Limited Function Referral Office Certification Form

Applicant Name(Required)

First Last

Please include agent's NAME and DRE LICENSE#(Required)

Certified by (Designated REALTOR®)(Required)

The exemption for any licensee included on the certification form shall automatically be revoked upon the individual being engaged in real estate licensed activities (listing, selling, leasing, renting, managing, counseling, appraising, or arranging financing for real property) other than referrals or upon their joining an MLS, and dues for the current fiscal year shall be payable.

First Last

Date(Required)

Signature of Designated REALTOR®(Required)

Name of Brokerage(Required)

Brokerage Name

Name of Referral-only LFRO DBA/Corp

Company Name

Phone(Required)

Email(Required)

CAPTCHA

Form | Limited Function Referral Office (LFRO)

Limited Function Referral Office Certification Form

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