EmailMe Form - BREVARD REGISTRATION FOR "HOME" PROGRAM

Registrant's Name *

First Last

Contact Info: (at least one must be provided)

Email

Phone

### - ### - ####

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

"HOME" program qualification type:

Preferred method of contact

Telephone

E-mail

Text

For Buyer Services:

Area desired

Type of Property Desired

Approx. Price Range

Additional requirements, criteria, or information: (i.e. #BRs, pool, time frame)

Do you need to sell a home before purchasing? *

Yes

No

For Selling Services:

Property Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

DSRE Agent: Frank Ripley

Other pertinent information that would be helpful to the agent selected:

VERIFICATION: By submitting this Registration, I confirm that I am qualified for the "Heroes On the MovE" program and will provide verification of same on request prior to receiving rebate at closing.

I acknowledge that the Rebate is calculated at 25% of the listing or selling commission received by DSRE in connection with its representation of the hero’s side of the transaction only. For listing transactions, rebate excludes compensation to cooperating broker (even if DSRE may also be cooperating broker) and “marketing/technology" fee. Maximum amount of rebate is $5,000. All rebates are subject to lender approval, if applicable.

Type name above and then press "Submit"