Arkansas Real Estate Commission
Phone: (501) 683-8010 FAX: (501) 683-8020
REAL ESTATE LICENSE – ACTIVATION (Inactive to Active)
INSTRUCTIONS
Complete and return this form with $30 fee. If applicable, attach proof of completing continuing or post-license education
requirement. Change shall become effective when all necessary form(s) and fee(s) are received and approved by the Arkansas Real
Estate Commission (AREC). Forms that are incomplete or not accompanied by the proper attachments will be returned to you.
PART A Completed by Licensee License Number: ___________________________
Name of Licensee: ____________________________________________________________________________________________
(First Name) (Middle Name or Initial) (Last Name)
Address: ____________________________________________________________________________________________________
City: _________________________________________________________ State: ___________ Zip: _________________________
Phone Number: _________________________________ Email Address: ________________________________________________
I request my real estate license be issued to the Firm below as:
Status: ___ Principal Broker ___ Executive Broker Designated ___ EB ___ Associate Broker ___ Salesperson
Signature of Licensee: ________________________________________________
PART B Completed by Principal Broker accepting responsibility for salesperson or broker in Part A
Firm Name: _________________________________________________________________________________________________
Firm Address: _____________________________________________ Firm PO Box: ______________________________________
Firm City: _______________________________________________ State: ________________ Zip: __________________________
Firm Phone Number (with area code): ________________________________ Fax Number: ________________________________
As Principal Broker/Executive Broker, I authorize the issuance of a real estate license with the above named firm.
Principal Broker/Executive Broker License #: __________________________________________________________
__________________________________________________________________________________________________
Principal Broker/Executive Broker Signature / Activation Date
PART C Complete only if LICENSEE WILL BECOME PRINCIPAL BROKER of a New or Existing Firm
I hereby accept the duties and responsibilities of the firm below and request that my real estate broker’s license be issued to this Firm.
Firm Name: _________________________________________________________________________________________________
Firm Address: _____________________________________________ Firm PO Box: ______________________________________
Firm City: _______________________________________________ State: ________________ Zip: __________________________
Firm Phone Number (with area code): ________________________________ Fax Number: ________________________________
Principal Broker/Executive Broker License #: _____________________________
_____________________________________________________________________
Principal Broker/Executive Broker Signature / Activation Date
Return to: Arkansas Real Estate Commission 612 South Summit St. Little Rock, AR 72201
REV (02/2013)
Receipt # ____________________
