Firm Address Change Request


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Contact Details

Firm Address Information
Current Address on Record with the Commission
New Address

How many Firms/Sole Proprietorships have been using this address?*

Only ONE Firm or Sole Proprietorship has been using this address

Multiple Firms/Sole Proprietorships have been using this address
NOTES:
  1. A broker may serve as Broker-in-Charge (BIC) at only one address. If one BIC has been designated for all firms/sole proprietorships at this address, but the address is not changing for all firms/sole proprietorships, one or more locations will no longer have a BIC and all brokerage activities must cease. If you are unsure whether this applies, please contact the Commission’s Education and Licensing Division at 919.875.3700 before completing this form.
  2. If firms are moving to separate addresses, complete a separate form for each unique address.
Enter the names and firm license numbers for all Firms/Sole Proprietorships that will use the new address. You may enter up to five locations on this form. If you need to add more locations please contact the Commission’s Education and Licensing Division.
Location #1
Location #2
Location #3
Location #4
Location #5

Signature and Certification

By signing below I certify that I am the designated Qualifying Broker and/or Broker-in-Charge of the Firm(s) or Office(s) as indicated above.

Date Signed

12/18/2017


Info
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Info
Processing Form...
107.20.115.174

This form is not meant to be printed. If you have already completed the form please use the submit button at the bottom to send the form directly to the Commission.