MLS Auto Pay Authorization Form

MLS AutoPay Authorization Form

"*" indicates required fields

MLS

Southwest Riverside County Association of REALTORS® offers quarterly Autopay for CRMLS users. Having your account on Autopay ensures the dues are kept current, avoiding suspension of services and/or late fees.

The MLS fees are processed in the first week of December, March, June, and September. You must notify SRCAR®, in writing, at least 14 days before the due date if you wish to cancel Auto-Pay. Dues are subject to change.*

Please initial agreeing to the above statement.

To update or change credit card information, please submit a new Credit Card Authorization Form. For your protection, we must have the request in writing. It is your responsibility to make sure SRCAR® has valid, current credit card information on file.*

Please initial agreeing to the above statement.

Name*

First Last

Office Name*

Email*

Cell Phone*

Type of Credit Card*

AMEX

Visa

MasterCard

Discover

Credit Card Number*

Expiration Date*

Security Code (CVC)*

Please enter a number from 00000 to 99999.

Name on Card (if different from above)

If the name on the card is different than the applicant, please share the name on the card here.

Billing Zip Code

If the billing zip code of the card is different than the applicant’s home address zip code, please share the card’s billing zip code here.

I authorize the Southwest Riverside County Association of REALTORS® to charge my credit/debit card each quarter as indicated above.

Signature*

Please type your full first name and last name in this field as your signature.

Last modified: April 10, 2024 at 2:02 pm | Originally published: April 10, 2024 at 12:21 pm
Printed: July 27, 2024