LOUISIANA REAL ESTATE
9071 Interline Avenue
Baton Rouge, LA 70809
(800) 821-4529 (LA only) or (225)
TERMINATION OF SPONSORSHIP OF A SALESPERSON OR ASSOCIATE BROKER
This form must be returned to the LREC within five (5) working days following the date
the form is signed.
If this document is not signed by both parties, the signing party must submit
proof that the other party has been notified of the termination via registered or
certified mail sent by the terminating party.
Proof of notification shall not be required if this document contains the signature of both the
sponsored licensee and the sponsoring broker.
1. Name of Sponsored Licensee:
License Number of Sponsored Licensee:
2. Name of the individual or Company that appears on the license as the sponsor:
License Number of the individual or company that appears on the license as the sponsor:
3. Sponsorship is being terminated at the request of the:
□ Sponsored licensee
□ Sponsoring broker
Signature of Sponsored Licensee/Date:
Signature of Sponsoring Broker/Date:
TOS Form Rev. 1/2017