PRINT, COMPLETE, SIGN & FAX TO (321) 206-4579

Florida Realty Solutions LLC
  
Phone: (407) 513-4173
Phone2: (407) 509-2854
Voice Mail: (321) 251-8046
Cell Phone: (407) 509-7917
Fax: (321) 206-4579




CASH REWARD PROGRAM REGISTRATION FORM

Name Home Phone (     )
Mailing Address Work Phone (     )
City                            State            Zip Cell / Pager (     )
Social Security # Email Address

ACKNOWLEDGEMENTS

I hereby acknowledge and agree that:

I am not an employee of Florida Realty Solutions LLC. Therefore, I am responsible for any income tax liability and for notifying the IRS of my earnings.

Either, Florida Realty Solutions LLC or I may choose to terminate my participation in the CASH REWARDS PROGRAM at any time and for any reason.

If I earn $600 or more during any calendar year, Florida Realty Solutions LLC will issue a 1099 IRS Form for tax purposes as required by law. Further, I will cooperate fully with the preparation of this form by supplying my Social Security Number to Florida Realty Solutions LLC as indicated above.


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