Rev. 5/6/2014
State of Utah
Department of Commerce
Division of Real Estate
REAL ESTATE COMPANY/BRANCH REGISTRATION
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
Complete, sign, and submit this form along with the items listed below by fax, mail, email, or in person.
APPLICATION FOR: ( ) Company ( ) Branch ( ) Property Management
New Entity Name:____________________________________________________________________________
Physical Address:____________________________________________________________________________
Mailing Address:____________________________________________________________________________
Phone #: _______________________ Fax #:_____________________
Principal/Branch/Dual Broker: ___________________________________
License #: ______________ Phone: _________________ Mobile: _________________
Email:
_____________________________________________
Company – include: (Refer to Real Estate Company/Branch Registration Checklist for more details)
Entity must be registered with the Utah Division of Corporations prior to submitting this form.
Change Card for the Company’s Principal Broker.
Documentation from a Utah bank or credit union less than 30 days old verifying an operating account.
Notarized letter on company letterhead authorizing the Broker to use the company name. (Note: This
is not required if the broker is the owner.)
Documentation from a Utah bank or credit union less than 30 days old verifying a real estate trust
account or property management account, if applicable, on which the Principal Broker is a signatory.
$200 non-refundable fee
Branch – include:
Change Card for the Branch Broker
Documentation from a Utah bank or credit union less than 30 days old verifying a real estate trust
account on which the Branch Broker is a signatory. (Proof of account not required if same account as
main office.)
Documentation from a Utah bank or credit union less than 30 days old verifying a real estate trust
account or property management account, if applicable, on which the Branch Broker is a signatory.
Notarized letter on company letterhead authorizing the Branch Broker to use the company name.
(Note: This is not required if the broker is the owner.)
$200 non-refundable 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 # __________________________________________ Expires ______________
Signature _______________________________________ CCV# _______________
*To be completed by Division Staff *
New Entity Lic. #: ________________
