Fillable Initial Real Estate Broker License Application (Louisiana Real Estate Commission)

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Initial Real Estate Broker License Application (Louisiana Real Estate Commission)

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The Initial Real Estate Broker License Application (Louisiana Real Estate Commission) form is 2 pages long and contains:

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  • 15 check-boxes
  • 52 other fields

Country of origin: US
File type: PDF

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Louisiana Real Estate Commission (LREC) aim to regulate real estate affairs in the state of Louisiana. LREC help protect the public interest during activites including real estate transactions.

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LOUISIANA REAL ESTATE COMMISSION
9071 Interline Avenue
Baton Rouge, LA 70809
(225) 925-1923 or (800) 821-4529 (LA only)
Initial Real Estate Broker License Application
for Corporations/Partnerships/Limited Liability Companies
Complete this form to apply for a Corporation, Partnership, of Limited Liability Company Broker License.
Read the instructions carefully, as certain requirements may require additional submissions. Personal
checks, company checks, cashier’s checks, and money orders are accepted. Make fees payable to the
Louisiana Real Estate Commission. Please do not send cash through the mail. Notify the Louisiana Real
Estate Commission of any disability that may require special accommodations, auxiliary aids, or services
with regard to the application process.
Initial license fee……………………………... $120.00
Recovery Fund fee…………………….......... $ 10.00
Application Processing fee…………………. $ 25.00
TOTAL
....................................................... $155.00
Prorat
ed Errors and Omissions Premium Schedule: Errors and Omissions Insurance premiums are not included in the total
application fee. Applicants that elect to participate in the LREC group errors and omissions insurance program must ADD the
appropriate premium to the total amount remitted. Applicants electing to obtain equivalent errors and omissions insurance coverage
in lieu of the group policy shall submit the Certification of Independent Coverage form before a license will be issued.
Jan
Feb
March April
May
June July
Aug
Sep
Oct
Nov
Dec
$136 $125 $114 $103 $93 $82 $71 $60 $50 $39 $28 $17
TYPE OF LICENSE FOR WHICH YOU ARE APPLYING:
Limited Liability Company
Corporation Partnership
1. GENERAL INFORMATION:
An Employer Identification Number (EIN) is also known as a federal tax identification number, and is used to identify a business
entity such as a Corporation, Partnership, or Limited Liability Company.
Enter employer identification number here
-
The name used by a Corporation, Partnership, or Limited Liability Company must be registered with the Secretary of State, and a
copy of said registration must be submitted with this application.
Registered name of Corporation, Partnership, or Limited Liability Company:
________________________________________________________________________________________________________
2. PREFERRED MAILING ADDRESS AND DAYTIME TELEPHONE NUMBER:
_______ ____________________________________
_______ ____________________________________
___________________________________________
Street number or P.O. Box
City, State, Zip+4
Parish/County
Daytime phone number
Email Address
( ) ___ ___ ___ - ___ ___ ___ ___
3. BUSINESS PHYSICAL ADDRESS AND TELEPHONE NUMBER: Same as mailing address
_______ ____________________________________
_______ ____________________________________
___________________________________________
( ) ___ ___ ___ - ___ ___ ___ ___
Street number
City, State, Zip+4
Parish/County
Business phone number
InitBrokCPL Rev. 01/2018
FOR LREC USE ONLY
_______ ____________________________________
Initial Real Estate Broker License Application for Corporation/Partnership/Limited Liability Company Page 2 of 2
4. REGISTERED AGENT FOR SERVICE OF PROCESS:
Name: _______________________________________________________________________________________
Preferred Mailing Address _______ ____________________________________
City, State, Zip+4 _______ ____________________________________
Parish/County ___________________________________________
Daytime phone number ( ) ___ ___ ___ - ___ ___ ___ ___
5. OFFICERS, DIRECTORS, PARTNERS, MANAGERS, AND PRINCIPLES:
List the names of the officers, directors, partners, managers, and principles who will actively participate in the real
estate business activities of the Corporation, Partnership, or Limited Liability Company in Louisiana. Use a separate
sheet, if necessary.
a. ________________________________________________________________ Broker Salesperson
b. ________________________________________________________________ Broker Salesperson
c. ________________________________________________________________ Broker Salesperson
6. DESIGNATED QUALIFYING BROKER:
The Designated Qualifying Broker is the real estate licensee authorized to apply for a Louisiana Real Estate Broker License on
behalf of and in the name of the herein named Corporation, Partnership, or Limited Liability Company. The Designated Qualifying
Broker shall be the licensee’s representative in all matters relating to its real estate license activities in Louisiana and in all matters
before the Louisiana Real Estate Commission.
Name: _________________________________________ License Number: _____________________________
On behalf of the Corporation, Partnership, or Limited Liability Company: (select only one option)
I elect to participate in the Louisiana Real Estate Commission group errors and omissions
insurance policy coverage, and I have enclosed the required premium.
or
I elect to obtain independent errors and omissions insurance coverage in lieu of the group policy
and have attached the Verification of Independent Insurance Coverage Form prescribed by the
Louisiana Real Estate Commission.
CERTIFICATION AND ACKNOWLEDGEMENT
I hereby certify that all and singular the facts set forth in the foregoing instrument are true and correct.
Signature of Designated Qualifying Broker:
____________________________________________________
Print Name: ____________________________________________________ Date: _____________________
InitBrokCPL Rev. 01/2018
I have attached the registration certificate issued by the Secretary of State to the Corporation,
Partnership, or Limited Liability Company.
I have attached a resolution ex
ecuted by a principal of the Corporation, Partnership, or Limited
Liability Company that designates a licensed individual real estate broker as the Qualifying Broker
and that the intent of the company is to conduct real estate activity.
The following two boxes must be checked and corresponding documents attached for form to be valid:
I have attached a copy of the trade name and/or trademark registration certificate issued by the
Secretary of State to the Corporation, Partnership, or Limited Liability Company.
The following box is optional, but if checked the corresponding document must be attached:
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Initial Real Estate Broker License Application (Louisiana Real Estate Commission)

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Completed 20 July 2020

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