New Member
Addition, Release or Transfer

DR’s: Print this form: Save and Use when there are changes
Today’s Date___________________________________________

Name of Agent_________________________________________

Request made by________________________________________

Person requesting information: E-mail________________________

Effective date__________________________________________

Office________________________________________________

Office phone number____________________________________

Office fax number_______________________________________

Check only one:         New Agent        Release        Transfer 

MLS company to be notified:       Madison        Milwaukee 

Roxie Ritter
Jefferson County Board of REALTORS®
330 E. Racine Street
Jefferson, WI  53549
Phone: (920) 674-5135
Fax:     (920) 674-5135
Email:   jcbr99@sbcglobal.net