Lucero MLS Interface Payment

Fields marked with * are required for Invoice.

How many producing agents? *
 
How many offices? *
MLS Board Interface? *
How many offices use MLS?*
 
Franchise Name: *
Complete for Upgrade Quote Only Complete to Purchase Upgrade (Completed from must be faxed or emailed as directed).
Company Name:
 
Contact Name:
 
Contact Title:
 
Contact Email:
 
Mailing Address:
 
City:
 
State:
 
Zip:
 
Phone:
 
Fax:
 
Customer ID:
 
The Following are Payment Options
Fillout your preferred option.
Payment Option 1: Pre-Authorized Payment
Financial Institution:  
Routing Number:  
Account Number:  
Account Holder:  
Payment Option 2: Credit Card (Visa or Master Card)
Exp Date:  
Card Number:  
Card Holder: