REAL ESTATE SPONSOR CARD
Illinois Department of Financial and Professional Regulation - Division of Real Estate
320 West Washington Street, 3
rd
Floor
Springfield, Illinois 62786
Real Estate Licensing - Phone: (800) 560-6420 Fax: (217) 782-3390
FPR.REALESTATE@ILLINOIS.GOV
• In order to change your sponsoring broker using this form, you must complete this form in its entirety and submit it
along with a $25 check or money order made payable to IDFPR to the above address.
• If you are a managing broker and wish to self-sponsor, you must complete the Sponsor Card on your own behalf.
• Retain a copy for the employee and a separate copy for the sponsoring broker.
EMPLOYEE INFORMATION
Employee’s individual address must be different from the sponsoring broker’s address, unless you are a self-sponsored
managing broker with an authorized office at your residence as set forth in 68 Ill. Admin Code 1450.610.
Date: License No.:
Name: Social Security No.:
Mailing Address:
City, County, State, Zip Code:
Telephone Number: E-mail Address:
Managing Broker Broker
Residential Leasing Agent
SPONSORING BROKER INFORMATION
Sponsoring Broker Name:
Sponsoring Broker D/B/A (if applicable):
Must be registered/certified with appropriate entity & filed with Department.
Sponsoring Broker License No.:
Mailing Address:
City, County, State, Zip Code:
Telephone Number: Designated Managing Broker License No.:
Designated Managing Broker Name: Designated Managing Broker Signature:
Revised 3/2021
Sponsoring Broker Email:
