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Scrub-to-Keys and Home Well Benefit Employees Registration

First name

Last name

Current Address

Email

Phone

Checkbox if you give permission to contact you via text.

Birthday

Month

Day

Year

Type of Membership

Scrub-to-Keys Member

Home Well Employee Member

Scrub-to-Keys -Individual Member Registration

Monthly Option ($4.99 monthly charge)$59.99

Scrub-t-Keys - Individual Member Registration

Pay in full Annual Option and save $10.00$49.99

Home Well Benefit Employee Sponsored Benefit

Home Well Benefit$0

Individuals who are sponsored by their present employer must register with name of company and their account code below.

Company name

Account Code

Member Category

Buyer

Seller

Both Buyer and Seller

Action Time Frame

Mortgage Pre-Approved

Yes

No

Non-Applicable

If so, Please indicate the Mortgage company name and contact person below and upload any Pre-Approval letters and/or Proof of funds to purchase.

Mortgage Company

File upload

Please upload any Pre-Approvals or Proof of funds documents.

Check this box if your in need of a Mortgage company to work with

Home Preference

Signature

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We are committed in providing the upmost in customer satisfaction. Please let us know how we are doing in making it easier in the registration process..

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