State of Florida Department of Business and Professional Regulation Florida Real Estate Commission Application for Sales Associate License Form # DBPR RE 1
If you have any questions or need assistance in completing this application, please contact the Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395. Note: Applicants must provide at least one physical address. For fees, instructions, and additional information, see Section VII, pages 8-10, of this application.
Section I – Application Type CHECK ONE OF THE APPLICATION TYPES ▪ Sales Associate License [2501/1010] FL Resident (Complete Sections I-V) non-FL Resident (Complete All Sections) ▪ Sales Associate License (See Section VII (2) (a) (i) (b) for more information) [2501/1011] Mutual Recognition - non-FL Residents Only (Complete All Sections)
If you are requesting mutual recognition, from what state are you requesting?
Section II – Applicant Personal Information PERSONAL INFORMATION
Social Security Number*
FULL LEGAL NAME
Last/Surname Birth Date (MM/DD/YYYY) First Gender Middle Suffix
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Male MAILING ADDRESS
Female
Street Address or P.O. Box
City County (if Florida address) Country
State
Zip Code (+4 optional)
CONTACT INFORMATION
Primary Phone Number Primary E-Mail Address
RESIDENCE ADDRESS (IF DIFFERENT THAN MAILING ADDRESS)
Street Address
City County (if Florida address)
State
Zip Code (+4 optional)
Country ADDITIONAL CONTACT INFORMATION (OPTIONAL) Fax Number
Alternate Phone Number Alternate Email Address
*Under the Federal Privacy Act, disclosure of Social Security numbers is voluntary unless specifically required by federal statute. In this instance, Social Security numbers are mandatory pursuant to Title 42 United States Code, Sections 653, 654, and 666(a); and Sections 455.203(9), 409.2577, and
