Arkansas Real Estate Commission
501 683-8010 FAX: 501 683-8020
REAL ESTATE LICENSE - TRANSFER FORM
Instructions: To transfer, complete all parts of the form. Submit $30 transfer fee.
Terminating principal broker is responsible for signing and returning license and pocket card
PART I - Terminating Principal, Executive or Designated Executive Broker completes
PART II - Transferring Licensee completes
PART III - New Principal, Executive, or Designated Executive Broker completes
PART I:
Licensees Name: ___________________________________________________________________________________
(First Name) (Middle Name or Initial) (Last Name)
License Number: _______________________________ Type of License ______________________________________
Effective Date: _______________________, this license is no longer associated with _____________________________
______________________________________________ _______________________________________________
Terminating Principal Broker (Please Print) Signature of Terminating Principal Broker
PART II:
I hereby certify that I am not taking, and will not take, any listings, management contracts, appraisals, lease agreements,
or copies of any such documents, or any other pertinent information belonging to the former principal broker or firm.
Signature of Licensee: _______________________________________________________________________________
Home Address: _____________________________________________________________________________________
City: _____________________________________________ State: ______________ Zip: ________________________
Home Phone: _________________________ Email Address: ________________________________________________
PART III:
I accept the responsibility for the actions of the above licensee and give consent for licensee to be licensed with the Firm
below as: ____ Designated Executive Broker ____ Executive Broker ____ Associate Broker ____ Salesperson
(Separate form needed) (Separate form needed)
Firm Name: _______________________________________________________________________________________
Firm Address: _______________________________________________ Firm PO Box: __________________________
Firm City: ________________________________________ Firm State: _____________ Firm Zip: _________________
Firm Phone Number (with area code): ___________________________________________________________________
*PB, EB or DEB License #: ______________________________________
____________________________________________ / ________________
*PB, EB or DEB Signature Activation Date
*(For transferring a license, a signature and license number is required.)
NOTICE: This form must be mailed or delivered to AREC immediately to serve as a temporary license. The
temporary license will be valid for only thirty (30) days from the date it was mailed or delivered to AREC, with the new
principal broker’s original signature, and
ONLY
Return to: AREC 612 South Summit St. Little Rock, AR 72201
when AREC has received notice of licensees’ termination by previous
principal broker.
REV (02/2013)
Receipt # ____________________________
