Frē List Benefit Enrollment Form Fill out the Frē List Benefit Enrollment Form below: "*" indicates required fields Full Name*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Veteran or First Responder* Veteran First Responder Which branch?Active Duty Start Date* MM slash DD slash YYYY Active Duty End Date MM slash DD slash YYYY Type of Discharge?(Bad Conduct or Dishonorable disqualifies benefit)Copy of DD214 or other proof of enlistment (not required at this time) Drop files here or Select files Max. file size: 250 MB. *Please do not share anything with your social security number.First Responder Occupation:(Police, Fire, EMS, etc.)Proof of employment/retirement (not required at this time)Max. file size: 250 MB.(Paystub, W2, etc.)*Please do not share anything with your social security number.Please note: Proof of military or first responder employment must be provided before a property can be listed.Are you ready to list now?* Yes No Great. We have your information and you’re ready to list! Click the submit button below to continue.Consent to Reply* I agree to be contacted by VMG Realty via call, text, email. To opt-out, reply STOP or unsubscribe.PhoneThis field is for validation purposes and should be left unchanged.
