Fill - Free fillable Property Management Sales Agent (PMSA) Designation (Utah DRE) PDF form

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

Ifpayingbycheck,pleasemakecheckspayableto:UtahDivisionofRealEstate

Visa MasterCard AmericanExpress

Card#:_______________________________Expiration:________________

Signature:________________________________________________CCV#:_______

Fill Online, Printable, Fillable, Blank Property Management Sales Agent (PMSA) Designation (Utah DRE) Form