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CLROE, LLC |
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dba Cliff Roe Realty, Inc. |
| 14263 86th Terrace |
| Seminole, FL 33776 |
| Phone: (727) 644-7209 |
| Date: ________________ |
| Name ________________________________________________________________________ |
| Mailing Address: ______________________________________________________________ |
| City, State, Zip code: ______________________________________/ ______ / _____________ |
| Authorized Signature ___________________________________________________________ |
| Phone: Area code_________________ No ___________________________________________ |
| Web Site URL Http://www.________________________________________________________ |
| E-mail: _________________________________________________________________________ |
| State _____________ Towns __________________________, ___________________________, |
| _________________________, _________________________, ___________________________, |
| _________________________, _________________________, ___________________________. |
| Complete the form, make a copy for your records and mail with a check to the address listed above. The fee is $100 for one town, $150 for two towns, $180 for three towns, $200 for four towns and $250 for five towns. Add an additional $50 for each additional town. You will be mailed an invoice 2 months prior to your renewal date next year which gives you the option to renew or cancel. |