DocuSign Envelope lD: 1778E348-848C-440A-91 C2-016C2A3SC9EC

tttnrcENTRALTs
KELLERWILLIAMS" REALTY

Agent lnformation
n1 roy Henry Fernandes
Name on TREC License
n1 roy
Name you go by:
2510 Peachtree Lane
Add
trlcki nney TX 75072
City: State: Zip Cod
a1 royfe rn@gmai 1 . com
Email:
8I76807037 T-Mobi I e
Cell Phone: Cell Phone Provider:
198369s9 rx
Driver's License # State lssued in
25npri 1 1975
Date of Birth: Gender: x Male Female
63s765093
social security #
o8o171s
RE License # License Expiration DaE:03 /
3L/25

na nu
Optional:TREC Login TREC Password:

Date First Started in Real Estate (approximate) 03/3r/23

Emergency Contact
Name: Heather Dawn Fernandes ph one:
972653246L
Relationship to Age nt:
. spouse

Have you ever been an agent at a KW Before? yES x NO

x
Are you a Veteran? _YES

Are you going to be a full{ime agent or part time?

NO
i ll-Time
ll

Shirt Size:_XS _S _M x L XL XXL XXXL

What languages do you speak other than Engl ish? Hindi, Konkan'i

KW Email Request:
a1 royfern fernsa
1
@kw.com,2 com

*uot o neal tv
]|||ij:rr",.:11".,
Are you currently a member of x MetroTex or_ccAR Board? or other Board
na
?