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Agent Notification of Change Form
To affiliate, transfer or sever an agent from an office.
Information Processing
Please check the appropriate boxes and complete all information requested below. A photocopy of your CalBRE license must accompany this form (except for notice of severance). If this form is faxed, there is no need to mail original. For additional information, call Member Services. Please allow 24 to 48 hours processing time.
Your First Name
*
Your Last Name
*
Your Email
*
Change Form Applies To?
*
Agent MLS
Assistant MLS
Office Manager
MLS ID Number
*
Change the following:
*
New Affiliation or Re-Affiliation
Inter-Office Transfer
Notice of Severance
CalBRE Form RE 214 has been submitted to the CalBRE
Name of Agent/Assistant/Office Manager
*
Agent Contact Number (MLS):
*
Preferred Fax
*
Firm address for Agent/Assistant/Office Manager
*
E-mail for Agent/Assistant/Office Manager
*
Agent Signature (for Assistant change)
*
Type name to acknowledge change
Broker Name
*
Broker Signature
*
Type your name below to accept terms
Date
*
Month
/
Day
/
Year
Firm Name
*
Firm Number
*
Submit