F400Series - Virginia REALTORS®

Experience Verification Form

Please print this form and have your broker complete and sign. Then, upload the completed form in the space indicated below.

About You

Name*

First Last

Your name as you would like it to appear on your certificate*

NRDS ID*

Your Email Address*

Your Local Association*

Name of Your Firm*

Firm Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address for Certificate (if different from above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone

Your Professional Photograph*

Accepted file types: jpg, gif, png, Max. file size: 100 MB.

We would like to recognize graduates of the PM Certified on our website and at our PM-related events.

Your Principal Broker

Please complete this section even if you are the broker.

Name of Your Principal Broker*

First Last

The name of the principal or supervising/managing broker for your office.

Principal or Supervising/Managing Broker Email Address*

Experience Verification Form*

Max. file size: 100 MB.

Please add COMPLETED verification form here.

Consent

Consent*

I agree to pay the certification fee.

Payment of the designation fee in the amount of $125.00 will be billed and payment must be made online. You will be sent an email from Virginia, REALTORS® (membership@virginiarealtors.org) with information on how to pay online.

To retain the rights to use the PM Certified credentials, you must maintain membership status with the Virginia REALTORS® and attend an annual VAR-sponsored Virginia Residential Landlord Tenant Act (VRLTA) update class.

I verify that all information given in this application is true and complete to the best of my knowledge.

Today's Date*

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Experience Verification Form

Please print this form and have your broker complete and sign. Then, upload the completed form in the space indicated below.

About You

Your Principal Broker

Consent

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