Application For Real Estate Branch Office License Form - Washington
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1REAL ESTATE LICENSING
BROKERS SECTION
APPLICATION FOR REAL ESTATE
P.O. BOX 9021
OLYMPIA, WA 98507-9021
BRANCH OFFICE LICENSE
(360) 586-0998
FAX (360)586-0998
!
New Branch Office License ....... $169.50
For Validation Only
!
Name Change ........................... $ 26.50
!
Change of Designated Broker ... $ 26.50
!
Change of Address .................... $ 26.50
Please type or print in dark ink - see page 2 for instructions/requirements
Make remittance payable to:
State Treasurer
To be completed by Designated Broker
Company information
If application information is incomplete, the application will not be processed.
Company Name
Branch Office Phone No.
(
)
Branch Address (Number, Street & P.O. Box if Applicable )
Business Fax No.
(
)
City
State
Zip
County
Main Office Address (number, street)
Main Office Phone
City
State
Zip
County
*
Designated Broker's Name (First, Middle, Last)
Designated Broker's Social Security No.
For address change only: previous address (Number, Street, City, State, and Zip)
Designated Broker please respond to the following questions:
1. What is zoning of the area in which the office is located?_____________________________
2. Is a real estate office permissible in this zone?
____Yes
____No
3. Are you or is your real estate firm the owner(s) of the business to be established at this
branch office location?
____Yes
____No
If not, please provide the name and residence mailing address of the owner in the space provided below:
4. Are you currently required to register as a sex offender in this state of any other state?
____Yes
____No
If yes, state ________ county________
Attach a letter of explanation for an affirmative answer to question 4.
*
State law, RCW 26.23.150, requires you to furnish your Social Security Number when you apply for this license. If this application
is for a business that is a sole proprietorship, the proprietor must furnish his/her Social Security Number. Resident aliens, without a
Social Secirity Number, must furnish their Individual Tax Identification Number.
I certify that the above information is true and correct.
Signature ________________________________________________________ Date ________________________
X
Designated Broker
See information/procedures on page 2
The Department of Licensing has a policy of providing equal access to its services. If
you need special accommodation, please call (360)753-2262 or TTY (360)753-1966.
RE-620-011 APP BRANCH OFF LIC (R/4/00)FM/W Page 1 of 2
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