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CHANGE OF ADDRESS (HOME/PHYSICAL/EMAIL) AND/OR PHONE NUMBER
Applicant Signature: ______________________________________________________ Date: __________________
(Mail, email, or fax this form to the designated division, using the contact information provided herein.)
CAT 11/18
Name as printed on License : __________________________________________________________________________
License Number: ____________________________________________________________________________________
A separate form must be submitted for each license needing a change.
Mailing Address:
Street: _____________________________________________________________________________________
City, State, Zip: _______________________________________________________________________________
Parish: _____________________________________________________________________________________
The commission requires a physical address for all licensees.
Physical Address:
The commission requires an email address for all licensees.
Personal email address: _____________________________________________________________________________
Phone Number:
Work: _____________________________________________________________________________________
Home: _____________________________________________________________________________________
Cell: _______________________________________________________________________________________
LOUISIANA REAL ESTATE
COMMISSION
9071 Interline Avenue
Baton Rouge, LA
70809
(800) 821-4529 (LA only) or (225)
925-1923
Fax (225)
925-4501
Street: _____________________________________________________________________________________
City, State, Zip: _______________________________________________________________________________
Parish: _____________________________________________________________________________________
Check if same as above.