Rev. 8/08/2013
State of Utah
Department of Commerce
Division of Real Estate
REAL ESTATE COMPANY/BRANCH CHANGE
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
Please complete (type or neatly print), sign and submit this form along with the items listed below by fax, mail, or in person.
CHANGE FOR: ( ) Company ( ) Branch ( ) Property Management Company
Company Name: ____________________________________________________________________________________________
Company License Number: ______________________________ Ph: _______________________ Fax: ______________________
Physical Address: ____________________________________________________________________________________________
____________________________________________________________________________________________________________
Mailing Address: ____________________________________________________________________________________________
____________________________________________________________________________________________________________
Broker: ______________________________________________ Broker License Number: _________________________________
Broker email: _________________________________________ Ph: _______________________ Cell: ______________________
( ) Activation – requirements: - Notarized letter on company letterhead authorizing activating Broker to use company name
(unless owned by Broker)
- Documentation from a financial institution less than 30 days old verifying a trust account and
an operating account on which the Broker is a signatory.
- Change Card for the Company’s Broker
- Change Card for each licensee affiliating with the Company
- $15 non-refundable activation fee
( ) Deactivation – requirements: - Letter stating company is closing, address of records, and information for a contact person
- Change Card for each licensee disassociating with the Company
- Change Card for the Company’s Broker
( ) Name Change* – requirements: - Company name active with the Utah Division of Corporations
- Letter on company letterhead authorizing name change (unless owned by Broker)
- Documentation from a financial institution less than 30 days old verifying a trust account and
an operating account on which the Principal Broker is a signatory.
- $100 non-refundable name change fee
- Old Company Name: __________________________________________________________
*Can only be used if company ownership is the same. If company ownership is different, must register as a
new company.
( ) Broker Change – requirements: - Notarized letter on company letterhead authorizing incoming Broker to use company name
(unless owned by Broker)
- Documentation from a financial institution less than 30 days old verifying a trust account and
an operating account on which the new Broker is a signatory. (Proof of accounts not required
if same accounts as
main office.)
- Change Card for the exiting Broker
- Change Card for the incoming Broker
- $50 non-refundable broker change fee
I hereby certify that the information provided with this application is true and correct.
Principal Broker Signature __________________________________________________________ Date ______________________
Branch Broker Signature ___________________________________________________________ Date ______________________
( ) Check ( ) Visa ( ) MasterCard ( ) American Express
Make checks payable to: Utah Division of Real Estate
Card #: _______________________________________ Expiration: ____________
Signature_______________________________________ CCV# ________________
