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Broker Registration

The following forms can be downloaded from our website and MUST be submitted for registration. Please note that if your company is a corporation, limited liability company, partnership, or limited liability partnership, you must use your EIN (Employee Identification Number) or FIN (Federal Identification Number) in all areas where these forms requests TIN/SSN.

SAMS 1111: Payee Name and Address

• Fill in boxes 2a-2c if your office will be using the tax id number, boxes 3a and 3b for social security number. They should be printed in ink. If you are an individual/sole proprietor registering with a SSN, your individual name (last, first, middle initial) should go in box 3 and your business name should go in box 9 along with your address.
• Did you complete items 7-16? They should be printed in ink. Only the designated or principal broker for each office can certify.
• Box 8 must contain a STREET address, Not a P.O. Box. Using a P.O. Box address is only acceptable as an alternative address in Box 10.
• Did you complete items 17-20?

SAMS 1111-A: Selling Broker Certification

• Have both signatures areas been signed and dated?
• If you are exempt from signing the Non-Discrimination agreement, did you include the name of the local board?
• Did you complete the broker information portion?
• Is the broker information the same as disclosed on the SAMS Form 1111? The information must be identical.

W-9: Request for Taxpayer ID Number and Certification

• Did you complete the top portion in its entirety? Address must match the address listed on SAMS Form 1111 and 1111-A.
• Did you complete Part I? Taxpayer ID must match the one disclosed on SAMS Form 1111 and 1111-A.
• Did the broker sign and date under Part II in BLUE Ink? The date must be current.

You Must Also Provide the Following:

• Copy of current Driver's License.
• Copy of Social Security Card, if registering with a social security number.
• Copy of Most Current Broker's License-Only one broker per office can be certified and he/she must be the principal or designated broker.

1. A corporation, associate, officer or branch office license is not acceptable.
2. The license must display an expiration date and cannot expire within 30 days of submitting the package.
3. The license number must be legible.
4. The license number must match the number provided on SAMS Form 1111-A.

• First Page of a Most Current Telephone Bill, Utility Bill or Bank Statement: Does the name/address on the bill/statement match the name/address in Box 3 and/or 9 on SAMS Form 1111? Please note that if you are using a P.O. Box mailing address, the street address (appearing in box 9) must appear somewhere on the bill/statement. P.O. Boxes are not acceptable for business address verification.

Recertification: Please remember that you must recertify annually and it will be your responsibility to track this date and submit a re-certification package timely to ensure that your bidding privileges are not interrupted. Please allow 4 to 6 weeks for a NAID number to be issued to you.

Broker Registration Forms:

	Broker Certification Package
	SAMS 1111
	SAMS 1111-A
	W-9

Upon completion, overnight (no faxes) your application to: