Form Re-620-135 - Application For Real Estate Corporation License printable pdf download

Real Estate Licensing

STATE OF WASHINGTON

APPLICATION FOR REAL ESTATE

Department of

P.O. Box 9021

Olympia, WA 98507-9021

CORPORATION LICENSE

(360) 753-2262 or FAX (360) 586-0998

(509) 921-2362 Spokane

FEES: Refer to page 2 of this form

FOR DEPARTMENT USE ONLY

Payable to STATE TREASURER

Please type or print

Please see reverse for additional requirements

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 phone

Company street address

Designated broker's residence phone

City

State

Zip

President

President's residence mailing address (street, city, state, zip)

V.President

V.President's residence mailing address (street, city, state, zip)

Secretary

Secretary's residence mailing address (street, city, state, zip)

Treasurer

Treasurer's residence 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

Does the corporation agree to establish and maintain a publicly accessible real estate office at the business address?

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.

1. With the exception of motor vehicle violations, have you or

3. Has any professional or occupational license or permit

any officer of the corporation ever been convicted of a crime,

issued to you or any corporate officer, or your right or the right

felony, or misdemeanor by this state, any other state, the

of any corporate officer to engage in any business ever been

federal government or any other jurisdiction within the past

refused, suspended, revoked, or denied in this state or any

ten years?

other jurisdiction?

Yes

(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 informa-

Yes

tion presently pending against you or any corporate officer, or

are you or any corporate officer under indictment in this state,

5. Are you currently required to register as a sex offender in this

any other state, by the federal government, or by any other

state or any other state?

jurisdiction?

Yes

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.

Designated Broker signature X______________________________________________________________________

The Department of Licensing has a policy of providing equal access to its services. If

RE-620-135 RE CORP. LIC. APP. (R/10/99)M/W Page 1 of 2

you need special accommodation, please call (360) 753-2262 or TDD (360) 753-1966.

Form Re-620-135 - Application For Real Estate Corporation License

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