Real Estate Agent Interest and Information Form

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Chuck Jonaitis, Managing Broker, GRI, ABR, SRES

2209 Sharon Road		Cumming, Georgia 30041
Office: 770.889.6090		Fax: 770.889.7742
eMail: Chuck@ChuckJonaitis.com

AGENT INFORMATION FORM
fields labeled in bold are required

Do you have a Georgia real estate license:

yes no

If so, how long have you been licensed:

Where are you presently working:

Any additional information you wish to share:

WELCOME

ABOUT CHUCK

LAKE LANIER

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