Application for Membership and Shares Form

The Board of Directors
Estate Agents Co-operative Ltd
2A/175 James Ruse Drive Rosehill NSW 2142

I would like to become a member of Estate Agents Co-operative Limited and submit the following information for your consideration:

Applicant's Name*

Trading Name*

Company Name

if applicable

Office Address*

Office Address Line 2

Office Suburb*

Office State*

Office Postcode*

Home Address*

Home Address Line 2

Home Suburb*

Home State*

Home Postcode*

Phone*

Fax

Mobile*

Office Email*

Member's Email*

Website

Individual Licence Number

Corporation Licence Number

Type of Real Estate Licences Held

Previous real estate businesses operated (if any) or real estate experience*

I am aware and acknowledge that:

We may refuse an application for membership without assigning a reason for that refusal.
Should my application be accepted I also apply for fifty (50) shares of $2 each in the capital of the Co-operative.
I agree to be bound by the Rules and By-laws of the Co-operative.

*

I have read and agree to the terms above.
I have read the Collection Statement and agree to my personal information being collected, used and disclosed by EAC in the manner stated. I also consent to receiving future communications from EAC in the manner described in the Collection Statement, including electronically.

Applicant's Name*

Application Date*

Name

This field is for validation purposes and should be left unchanged.