Meridian Home Solutions, Inc. , associate registration, broker registration

Associate Registration, please complete and read below before clicking Submit.

Personal Information

First Name:

Middle Initial:

Last Name:

Mailing Address:

City:

State:

Zip Code:

E-mail Address:

Business Phone:

Cell Phone:

Business Fax:

Business Information

Company Name

Company Type:

Realty

Mortgage

Position:

Broker-in-Charge	If Other Type/Position please list:
Agent/Loan Officer

Time with Company:

Full Time Part Time For: Yrs. Mo.

If Not Office Manager/BIC please provide;

Name: Phone:

Service Area (Counties, Cities, etc.)

Program Information

How did you complete Program Explanation and Understanding?

Live Presentation

Online Exam

Not Completed

How did you hear about Lease Purchase Protection?

Have you spoken to someone? Yes No

If yes, who? Their Name:

Please ensure that the information provided is complete and accurate. Payment of Meridian commissions will be contingent on office completion and return of a W-9 form. Consult with your Office Manager/BIC for proper W-9 filing.

Registered Associates are required to use the Lease Purchase Protection program in compliance with all Meridian regulations and State/Federal laws. Associates will hold the right to distribute program information, collect customer applications for processing and with approval, submit required forms for enrollment. All verbal and physical program information released by Registered Associates will remain limited and uniform. No descriptions, content, material, logos, slogans, references, etc... will be altered, reproduced and/or distributed without the written consent of Meridian Home Solutions, Inc.

Meridian Home Solutions, Inc. is not responsible for any altered or fraudulent information released by Registered Associates and/or affiliates and holds the right to suspend and/or revoke registrations of Associates for such. With full compliance, once Registered Associates have conducted duties they are indemnified from program procedures and contracts that will be issued between Meridian and customers.

I, the above stated, agree and acknowledge that the above information is correct. I further acknowledge that I have read and understand the above stated policies, and agree to adhere to them as a Registered Associate.

Associates Name:		Date:
by submitting this form you are agreeing to terms and conditions of Meridian Home Solutions, Inc.

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