Regulation and Licensing Department
Regulation and Licensing Department
NEW MEXICO REAL ESTATE COMMISSION
5500 San Antonio Dr. NE, Suite B
Albuquerque, New Mexico 87109
(505) 222-9824
REAL ESTATE BROKER’S ADDITIONAL LICENSE APPLICATION
FOR FEE CALL THE R.E. COMMISSION OFFICE/LICENSING DEPT
______________________________________________________ ______________________________________
1. APPLICANT NAME Individual Tax ID Number
_____________________________________________________________ _______________________________
RESIDENCE LOCATION (DO NOT USE PO BOX) PHONE #
______________________________________________________ ______________________________________
RESIDENCE MAILING ADDRESS (IF DIFFERENT) DATE OF BIRTH
______________________________________________________________________________________________
CITY STATE ZIP CODE
E-MAIL ADDRESS:_______________________________________________________________________________
Indicate the status you are seeking (select only one): _____ Associate Broker _____ Qualifying Broker
==============================================================Please select all that apply and provide company information below:
New Company/or location_____ Existing Company____ & Property Management: yes /no
______________________________________________________________________________________________
CORPORATION NAME
______________________________________________________________________________________________
TRADE NAME/DBA
__________________________________________________________ __________________________________
BUSINESS LOCATION (STREET NAME AND NUMBER) BUSINESS PHONE NO.
______________________________________________________________________________________________
BUSINESS MAILING ADDRESS (IF DIFFERENT)
______________________________________________________________________________________________
CITY STATE ZIP CODE
==============================================================
I hereby certify that all of the information contained in this completed form is true and correct to the best of my knowledge and belief.
__________________________________________ _______________________________________________________
SIGNATURE OF APPLICANT SIGNATURE OF QUALIFYING BROKER (License # if applicable)
_______________________________________ ____________________________________________________
SIGNATURE OF PARTNERS/OWNERS SIGNATURE OF AUTHORIZED CORPORATE OFFICER
REVERSE SIDE OF THIS FORM MUST BE COMPLETED
REVISED 03/18
Do you have an errors and omissions insurance policy? (Attach Copy)
YES [_____] NO [_____]
Insurance Co. Name:___________________________________________________
Effective Date:_______________________ Expiration Date:__________________
==============================================================
TO: NEW MEXICO REAL ESTATE COMMISSION
CONSENT TO EXAMINE AND AUDIT
I, ___________________________, being a licensed New Mexico real estate broker or broker applicant hereby authorize the New Mexico Real Estate Commission or its authorized representative to examine and audit the trust, trustee, or escrow account maintained by me pursuant to Section 61-29-12 (11) N.M.S.A. 1978 Compilation, and the Commission rules regarding such trust, trustee, or escrow accounts and further authorize any bank or recognized depository to permit such examination and audit. This consent and authorization is made personally and/or corporately.
______________________________________
Signature of applicant
REVISED 03/18
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