Agent Information Form Your Name First Last License Number License TypeChoose oneSalespersonBroker AssociateLicensed Assistant SSN # Birthdate Month Day Year 4 Digit Security Code Have a RE/MAX ID? Enter it here. Home Address Street Address Address Line 2 City ZIP Code Personal Email Address* Cell Phone*Home Phone Spouse's Name First Last If you have kids or grandkids, share their names.Share some of your hobbies & interests