Central New York Information Service, Inc

CENTRAL NEW YORK INFORMATION SERVICE, INC. APPLICATION FOR AFFILIATE MEMBERSHIP

Applicant’s Name: ______Company: ______Address: ______City: ______State/Zip______Phone Number: (_____)______Fax(_____)______Cell Phone: (_____)______Email: ______

Please describe the service/products that are offered by your firm/organization: ______

Please describe your purpose for applying for membership to the CNYIS, Inc.: ______

Have you ever been convicted of felony or a misdemeanor? ___ yes ___ no If yes has been marked, please explain. ______

Have you ever filed bankruptcy or have a pending bankruptcy? ___ yes ____ no

I hereby submit my application for Affiliate membership in the Central New York Information Service, Inc. Enclosed with this application is my application fee of $50.00, to be refunded, in the event of non-acceptance to membership. Also enclosed is proof of my Liability Insurance coverage.

____ Check here for Supra Key Box Access.

If accepted, I agree to abide by the CNYIS Key Box Rules and Regulation and understand I need to be an affiliate member of the Greater Syracuse Association of REALTORS®. I understand that all applicants must have a scheduled appointment either with the REALTOR® or the homeowner before entering a home I understand that if I loan or give out my key, there will be a $1,000.00 fine, and/or suspension or revocation of the use of the key. I am aware that the Key Box Access fee will be $300.00 annual fee to CNYIS, $100.12 semi-annually to Supra plus a $50.00 activation fee for the Active Key. I understand upon acceptance, I am to pay the pro-rated Key Box fee for the current calendar year. ______Date Signature of Applicant

Return this completed application with your application fee enclosed to: Central New York Information Service, Inc. Denise Yerdon 1020 7th North Street , Suite 140 Liverpool, NY 13088

______Date Received Date Approved by Directors

Last Updated 11/12/17