Property Management Sales Agent (PMSA) Designation
(This application is ONLY to be completed by licensees who are currently affiliated with the
Property Management Company of a Real Estate DUAL BROKER)
Please complete (type, or neatly print), sign, and submit this form including the items listed
below, along with a $50 non-refundable fee to the Utah Division of Real Estate
by fax, email, mail, or in person, at the address listed below.
Name of Licensee: _____________________________ License No. : _______________
Email: _______________________ Phone:________________ Cell:________________
Physical Address:________________________________________________________
Mailing Address:_________________________________________________________
Licensee Signature: _______________________________________Date: ___________
Name of DUAL BROKER: _________________________________________________
Name of Real Estate Brokerage of Dual Broker: ________________________________
Name and License Number of Property Management Company of Dual Broker:
_____________________________________________ License No. : _______________
DUAL BROKER SIGNATURE:_______________________________________________
License No.: __________________________________ Date: ____________________
Designation Requested:
Property Management Sales Agent
Removal of Property Management Sales Agent (No Fee)
This designation is ONLY for licensees who are currently
affiliated with the Property Management
Company of a Real Estate DUAL BROKER. Licensees who subsequently change dual broker affiliation
will have their property management sales agent designation involuntarily removed by the Division.
Rev. 05.05.2017 160 East 300 South, PO Box 146711, Salt Lake City, UT 84114-6711
Telephone (801) 530-6747 * Facsimile (801) 526-4387 * Internet: www.realestate.utah.gov * Email: realestate@utah.gov
Ifpayingbycheck,pleasemakecheckspayableto:UtahDivisionofRealEstate
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Card#:_______________________________Expiration:________________
Signature:________________________________________________CCV#:_______