Form Re-620-135 - Application For Real Estate Corporation License - Wa Department Of Licensing
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1REAL ESTATE LICENSING
P.O. BOX 9048
OLYMPIA, WA 98507-9048
APPLICATION FOR REAL ESTATE
(360) 664-6488 or (360) 664-6500
FAX (360) 586-0998
CORPORATION LICENSE
Click Here to Start, Then Tab From Field to Field
FOR VALIDATION ONLY
Make remittance payable to State Treasurer.
FEES: Refer to page 2 of this form
Send this application with your remittance to:
Please type or print clearly in dark ink
Department of Licensing
PO Box 9048
See page 2 for additional requirements
Olympia, WA 98507-9048
Corporation information
If application information is incomplete, the application will not be processed.
Name of Corporation
DBA Name (if Applicable)
*
Designated Broker's Name
Social Security No.
Business Telephone No.
(
)
Company Address (Number, Street and Post Office Box if Applicable)
Designated Broker's Telephone No.
(
)
City
State
Zip
President
President's Mailing Address (Street, City, State, Zip)
V.President
V.President's Mailing Address (Street, City, State, Zip)
Secretary
Secretary's Mailing Address (Street, City, State, Zip)
Treasurer
Treasurer's Mailing Address (Street, City, State, Zip)
For Change of Address Only, Former Address (Street, City, State, Zip)
For Change of Designated Broker Only, Name of Outgoing Broker
For Company Name Change Only, Former Company Name
Office Location Zone Designation
Is a real estate office permitted in this zone?
Yes
No
Does the corporation agree to establish and maintain a publicly accessible real estate office at the business address?
Yes
No
*
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 Security Number, must furnish their Individual Tax Identification Number.
Attach a letter of explanation for any affirmative answer(s) to the following questions.
3. Has any professional or occupational license or permit
1. With the exception of motor vehicle violations, have you or any
issued to you or any corporate officer, or your right or the
officer of the corporation ever been convicted of a crime, felony,
right of any corporate officer to engage in any business ever
or misdemeanor by this state, any other state, the federal
been refused, suspended, revoked, or denied in this state or
government or any other jurisdiction within the past ten years?
any other jurisdiction?
Yes
No
Yes
No
(NOTE: If you or any corporate officer have been convicted
4. Have you or any corporate officer ever had a civil court
of a crime, you will be subjected to an investigation, and you
order, verdict, or judgement entered against you in any court
may be denied a license.)
of competent jurisdiction in which the subject matter involved
any real estate or business related activity?
2. Is there a criminal complaint or accusation, or other
Yes
No
information presently pending against you or any corporate
officer, or are you or any corporate officer under indictment
5. Are you currently required to register as a sex offender in
in this state, any other state, by the federal government, or
this state or any other state?
Yes
No
by any other jurisdiction?
Yes
No
If yes, state ______ county________
The designated broker agrees to personally manage and act for and on behalf of the corporation. Failure to comply with any provision of the
Real Estate Licensing Act or any rule or regulation promulgated thereunder may result in suspension or revocation of license.
X
Designated Broker signature
______________________________________________________________________
Upon filing, this application becomes a public record and is subject to public disclosure provisions pursuant to RCW 42.17
The Department of Licensing has a policy of providing equal access to its services. If
you need special accommodation, please call (360) 664-6500 or TTY (360) 664-8885.
RE-620-135 RE CORP. LIC. APP. (R/10/02)M/W Page 1 of 2
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