Fillable Real Estate License - Activation Form printable pdf download

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Arkansas Real Estate Commission

Phone: (501) 683-8010 FAX: (501) 683-8020

REAL ESTATE LICENSE – ACTIVATION (Inactive to Active)

INSTRUCTIONS

Complete and return this form with $30 fee. If applicable, attach proof of completing continuing or post-license education

requirement. Change shall become effective when all necessary form(s) and fee(s) are received and approved by the Arkansas Real

Estate Commission (AREC). Forms that are incomplete or not accompanied by the proper attachments will be returned to you.

PART A Completed by Licensee

License Number: ___________________________

Name of Licensee: ____________________________________________________________________________________________

(First Name)

(Middle Name or Initial) (Last Name)

Address: ____________________________________________________________________________________________________

City: _________________________________________________________ State: ___________ Zip: _________________________

Phone Number: _________________________________ Email Address: ________________________________________________

I request my real estate license be issued to the Firm below as:

Status: ___ Principal Broker ___ Executive Broker Designated ___ EB ___ Associate Broker ___ Salesperson

Signature of Licensee: ________________________________________________

PART B Completed by Principal Broker accepting responsibility for salesperson or broker in Part A

Firm Name: _________________________________________________________________________________________________

Firm Address: _____________________________________________ Firm PO Box: ______________________________________

Firm City: _______________________________________________ State: ________________ Zip: __________________________

Firm Phone Number (with area code): ________________________________ Fax Number: ________________________________

As Principal Broker/Executive Broker, I authorize the issuance of a real estate license with the above named firm.

Principal Broker/Executive Broker License #: __________________________________________________________

__________________________________________________________________________________________________

Principal Broker/Executive Broker Signature

/ Activation Date

PART C Complete only if LICENSEE WILL BECOME PRINCIPAL BROKER of a New or Existing Firm

I hereby accept the duties and responsibilities of the firm below and request that my real estate broker’s license be issued to this Firm.

Firm Name: _________________________________________________________________________________________________

Firm Address: _____________________________________________ Firm PO Box: ______________________________________

Firm City: _______________________________________________ State: ________________ Zip: __________________________

Firm Phone Number (with area code): ________________________________ Fax Number: ________________________________

COMMISSION USE ONLY

Principal Broker/Executive Broker License #: _____________________________

_____________________________________________________________________

Receipt # ____________________

Principal Broker/Executive Broker Signature

/ Activation Date

Return to: Arkansas Real Estate Commission 612 South Summit St. Little Rock, AR 72201

REV (02/2013)

Real Estate License - Activation Form