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Louisiana Real Estate Commission
9071 Interline Avenue
Baton Rouge, LA 70809
(225) 925-1923 or (800) 821-4529 (in state only)
License/Certificate Verification Request Form
Make fee payable to the Louisiana Real Estate Commission……………………….$25.00
Personal checks, cashier’s check, and money orders are accepted. We recommend that
you do not send cash by mail.
License Number: _________________________________
Name: _______________________________________________________________
Salesperson □ Broker □ Other □ _________________________________________
Address: _____________________________________________________________
City, State, and Zip: ____________________________________________________
Address where verification is to be sent if different than address listed above:
Address: _____________________________________________________________
City, State, and Zip: ____________________________________________________
Requested by: _________________________________________________________
Signature: ____________________________________________________________
Date: ________________