Request FIRM Name Change and/or Request to Replace
FIRM License Certificate or Pocket Card


An image of the North Carolin Real Estate Seal.


Request Details
I hereby certify to the North Carolina Real Estate Commission that:*
*Please note that a Qualifying Broker may view/download/print the firm’s digital pocket card for no charge by logging into his/her license record.




I hereby certify to the North Carolina Real Estate Commission that:*
*Please note that a Qualifying Broker may view/download/print the firm’s digital pocket card for no charge by logging into his/her license record.
The legal name of the firm has changed OR an assumed name has been added or removed. Please mail an updated license certificate ($5 fee required). I will download an updated digital pocket card (at no charge) once my firm name change has been processed.

The legal name of the firm has changed OR an assumed name has been added or removed. Please mail an updated license certificate ($5 fee required) and an updated paper pocket card ($5 fee required).*
Location #1
Location #2
Location #3
Location #4
Location #5
Legal Name Change Requirements
In the File Upload section please attach documentation that shows the Firm's new legal name. Examples: Name Change Amendment filed with the NC Secretary of State (for Corporations, LLCs, Limited Partnerships) or documentation filed with Register of Deeds office (for General Partnerships).
Assumed Name Eliminated Requirements
In the File Upload section please attach a copy of the Withdrawal of Assumed Name Certificate.
Remember to attach a Withdrawal Certificate for each location that has been eliminated.

Assumed Name Added Requirements
In the File Upload section please attach a copy of the Assumed Name Certificate/Registration.
Remember to attach a Registration for each location where the assumed name has been added.
Assumed Name Both Eliminated and Added Requirements
In the File Upload section please attach a copy of the Withdrawal of Assumed Name Certificate and the NEW Assumed Name Certificate/Registration.
Remember to attach a Withdrawal Certificate for each location that has been eliminated and a Registration for each location where the assumed name has been added.

File Upload

Attach a Withdrawal Certificate for each location that has been eliminated and a Registration for each location where the assumed name has been added.*
*Accepted File Types: .tiff .tif .jpeg .jpg .txt .pdf .docx .doc .png
*Max file upload size 10MBs total.

Total File Upload Size: 0.000*Mb

*Selected file(s) size exceed upload limitations of 10MBs


Signature and Certification

(Type your name)

Date Signed

12/18/2017


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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.