TBBOR: Affiliate Transfer Form

This form is used for Affiliates transferring from one office to another.

Fields marked with an * are required.

Member/Subscriber Information
Please provide the following information:

First Name *

Member's First Name

Last Name *

Member's Last Name

New Email (If changing)

Transferring Information
Please provide the following information regarding the office you have or will be transferring to.

Effective Date *

Effective date of the transfer.

Organization *

Company Name Transferring to.

Address Line 1 *

City *

State *

Postal Code *

Acknowledgement

I understand and acknowledge the following: *

There is a $25 transfer fee that will be added to your account on the Member Info Hub.
All service agreements with TBBOR will remain in effect, unless otherwise terminated.

I AGREE