Real Estate Commission

Address/Name Change Notification

- Please use the form below to report address/names changes, and click submit.

Instructions:

1. Change Residence Address:

(IF LICENSED AS AN INDIVIDUAL BROKER, COMPLETE SECTIONS 1 AND 2, EVEN IF THE ADDRESSES ARE THE SAME OR ARE NOT CHANGING.)

First Name: (Required)
Middle Initial:
Last Name: (Required)
License Number:
Street/PO Box (line 1):
Street/PO Box (line 2 if needed):
City:
State:
Zip Code:
Email:
Phone Number with Area Code:
(even if not changed)
Cell Number with Area Code:
(even if not changed)

2. Change Business Address

ONLY FOR INDIVIDUAL BROKERS, CORPORATIONS, PARTNERSHIPS, OR ASSOCIATIONS (LLC)
(If licensed as an Individual Broker, complete sections 1 and 2, even if the addresses are the same or are not changing.)

If licensed as an Individual Broker, enter name as it appears on license:
(Do Not Use DBA/fictitious name)
First Name: Middle Initial: Last Name:

 

If licensed as a Corporation, Association (LLC), Partnership, enter name of
company as it appears on license:
(Do Not Use DBA/fictitious name)

 

License Number:
Physical Business address:
(Number, Street) (PO Box not acceptable)
City:
State:
Zip Code:
Business Phone Number with Area Code:
(even if not changed):
Mailing Address of Business if different than above:
(i.e. PO Box):
City:
State:
Zip Code:
Email:

3. Change Individual Name or Add Alias/Nickname:

Previous Name:
First Name: Middle Initial: Last Name:
New Name:
First Name: Middle Initial: Last Name:
Aliases or Nicknames:
License Number:

Code
Please type the numbers displayed above in the box below.