Fillable Employing Broker Branch Office License App BPR FORM 31-004

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Employing Broker Branch Office License App BPR FORM 31-004

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DBPR YS 6000-4
Rev: October 2001
EMPLOYING BROKER'S BRANCH OFFICE LICENSE APPLICATION
Pursuant to Chapter 326, Florida Statutes, the undersigned licensee herewith applies for a
BROKER'S BRANCH OFFICE LICENSE. I understand that this license shall reflect the
expiration date of my broker's license, and if not renewed on or before the renewal date, this
license will automatically expire.
Based on the expiration date of your license, ATTACH THE APPROPRIATE FEE FOR THIS
BRANCH OFFICE LICENSE:
o For a period of 6 months or less $25.
o For a period between 6 months and 1 year $50.
o For a period between 1 year and 18 months $75.
o For any period exceeding 18 months $100.
Name of Broker______________________________________________________
License Number __________________________________________________
Telephone Number___________________________________________________
Name of Main Office__________________________________________________
Street Address of Main Office___________________________________________
___________________________________________________________________
Branch Office Address ________________________________________________
___________________________________________________________________
Branch Office Telephone Number ______________________________________
______________________________
Signature of Broker
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Employing Broker Branch Office License App BPR FORM 31-004

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Completed 3 July 2020

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