REAL ESTATE COMPANY/BRANCH CHANGE
State of Utah
Department of Commerce
Division of Real Estate
Please complete (type or neatly print), sign and submit this form along with the items listed below by fax, mail, or in person.
CHANGE FOR: ( ) Company ( ) Branch ( ) Property Management Company
Company Name:
Company License Number:
Ph: Fax:
Physical Address:
Mailing Address:
Brokers Name: Brokers License Number:
Broker Email: Ph: Cell:
( ) Check - Please make checks payable to: Utah Division of Real Estate
( ) Visa ( ) MasterCard ( ) American Express
Card #: Expiration:
Signature CCV#
( ) Activation – requirements: - Company name active with the Utah Division of Corporations
- Notarized letter on company letterhead authorizing activating Broker to use company name.
(Unless owned by Broker)
- Documentation from a financial institution less than 30 days old verifying a trust account and
an operating account on which the Broker is a signatory.
- Change Card for the Company’s Broker
- Change Card for each licensee affiliating with the Company
- $15 non-refundable activation fee
( ) Deactivation – requirements: - Letter stating company is closing, address of records, and information for a contact person
- Change Card for each licensee disassociating with the Company
- Change Card for the Company’s Broker
( ) Name Change* – requirements: - Company name active with the Utah Division of Corporations
- Letter on company letterhead authorizing name change (unless owned by Broker)
- Documentation from a financial institution less than 30 days old verifying a trust account and
an operating account on which the Principal Broker is a signatory.
- $100 non-refundable name change fee
- Old Company Name:
*Can only be used if company ownership is the same. If company ownership is different, must register as a
new company.
( ) Broker Change – requirements: - Notarized letter on company letterhead authorizing incoming Broker to use company name.
(Unless owned by Broker)
- Documentation from a financial institution less than 30 days old verifying a trust account and
an operating account on which the new Broker is a signatory. (Proof of accounts not required
if same accounts as
main office.)
- Change Card for the exiting Broker
- Change Card for the incoming Broker
- $50 non-refundable broker change fee
I hereby certify that the information provided with this application is true and correct.
Principal Broker Signature Date
Branch Broker Signature Date
Rev.10/16/2018
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
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