Georgia Real Estate CommissionGeorgia Real Estate Appraisers Board229 Peachtree Street NESuite 1000 - International TowerAtlanta, GA 30303-1605Phone: 404-656-3916Email: [email protected] a Firm ApplicationThis form can be filled out on-line. Print TWO copies: one to sign and submit for processing and one for your records. If a fee and/ordocumentation are required, attach to the application and mail to the address above. The license is issued for (4) years. Once the completedapplication, including all supporting documents, is received the license will be issued within 15 business days. An application requiring backgroundinvestigation will require additional time to process. Incomplete applications will be returned unprocessed and result in a 25.00 charge.For the Broker: Attach a notarized Lawful Presence Verification form and a Secure and Verifiable Document, as detailedon our website. (If not already on file with GREC)Include a non-refundable, license fee paid by a cashier's check or money order for 275.00 made payable to theGeorgia Real Estate Commission. This is an additional fee to the fee required for an individual Broker License.For the Broker: Attach a Georgia Criminal Information Center report (GCIC) if you are a Georgia Resident. If you are nota resident of Georgia, attach an equivalent report from your state of residency. This report must not be more than 60 daysold. A report from a party other than a law enforcement agency is not acceptable. Any incident listed on the report mustreceive clearance. In addition, you must disclose any conviction, nolo contendere plea, or first offender sentence notreflected on the report.Attach supporting documentation, if required, in section B and D.Resident FirmsCorporation- attach a Certificate of Incorporation*LLC- attach a Certificate of Organization*Limited Partnership- attach a Certificate of Partnership*General Partnership- attach a Partnership AgreementNon- Resident FirmsLimited Partnership- attach a Certificate of Authority*Corporation- attach a Certificate of Authority*GeneralPartnership- attach a Partnership AgreementLLC- attach a Certificate of Authority**Obtain from the Georgia Secretary of State's officeIf the Broker needs to become licensed in Georgia, submit a Real Estate Reciprocal Application' along with thisapplication. Reciprocal applicants do not complete section B.Section AFirm InformationThe control number for Corporations, LLC's, and Limited Partnerships isassigned by the Georgia Secretary of State after filing with the CorporationsDivision. You can locate this number on the certificate issued or on the website.Company Type:(www.sos.state.ga.us).Secretary of StateControl Number:Residency Status:Firm Name:Note: Firm Name for a Sole Proprietorship must include the Broker's First and Last Name OR Attach a copy of the Registered Trade Name CertificationFirm Name for a Corporation or LLC must match the Certificate of Organization or Authority OR Attach a copy of the Registered Trade Name CertificationRegistered TradeName:If a franchise, both the firm name and the franchise name must appear in the registered name. The trade name must be registered in each county where the firm willdo business.FOR OFFICE USE ONLYRec DtRec ByGREC OPEN A FIRM 01.2021FeeProc By & Proc DatePage 1 of 6CodesPLSReset FormPIINVPrint FormLIC#
Georgia Real Estate CommissionGeorgia Real Estate Appraisers Board229 Peachtree Street NESuite 1000 - International TowerAtlanta, GA 30303-1605Phone: 404-656-3916Email: [email protected] Address:City:County:State:Zip Code:State:Zip Code:Business Phone:Mailing Address:City:County:Alternate Phone:Email:Section BBROKER INFORMATIONGA Licensed Brokers OnlyGA License Number:Broker Name:ANSWER QUESTION (1) THEN FOLLOW THE INSTRUCTIONS UNDER THE QUESTION(1) Does the Broker need to activate an inactive Georgia License?If Yes, PROCEED TO SECTION CIf No, proceed to # 2YESNOYESNOYES(3) Will the Broker remain the Broker of the Firm(s)?If Yes, proceed to # 4If No, a Change of Qualifying Broker / Firm Change Application must be submitted with this formNO(4) Is the Broker currently affiliated, as an Associate Broker, with another Firm in Georgia?If Yes, proceed to # 5If No, PROCEED TO SECTION CYESNO(5) Will the Broker continue to be affiliated with this Firm as an Associate Broker?If Yes, proceed to # 6If No, proceed to # 7YESNO(2) Does the Broker currently operate any Firm(s) other than the one on this application?If Yes, proceed to # 3If No, proceed to # 4(6) You must have notified your Broker in writing, that you will be the Broker of the Firm listed on this application.[Rule 520-1-07(4)] PROCEED TO SECTION C(7) The Broker of the Firm where you are an Associate Broker, must release you from that Firm bycompleting and signing in this section. PROCEED TO SECTION CFirm License :Firm Name:Print Name of Broker:Office Phone :Date:Broker's Signature:GREC OPEN A FIRM 01.2021Page 2 of 6Reset FormPrint Form
Georgia Real Estate CommissionGeorgia Real Estate Appraisers BoardSection C229 Peachtree Street NESuite 1000 - International TowerAtlanta, GA 30303-1605Phone: 404-656-3916Email: [email protected] / Trust Account(1) Will this applicant company and its agents receive real estate escrow / trust funds?If YES, complete the required Escrow / Trust Account information at # 2YESNOIf NO, sign and date the waiver at # 3.(2) ESCROW / TRUST ACCOUNT INFORMATIONBy law, all escrow / trust accounts must be federally insured checking accounts and used only to deposit the funds of others inreal estate brokerage transactions.Institution Name:Account Number:(3) ESCROW / TRUST ACCOUNT WAIVERI, the undersigned broker, do hereby certify that (1) this firm has no plans to hold trust funds in any real estate brokeragetransaction and (2) if this firm does become the custodian of any escrow / trust funds in a real estate brokerage transaction,I shall see that the required escrow / trust account is opened within one business day of the receipt of such funds andimmediately notify the Georgia Real Estate Commission.Brokers Signature:Date:(4) FIDELITY BOND OR INSURANCE COVERAGE - (Only Firms that provide Community Association Management)Firms that provide community association management services and collect, maintain, control, have access to, or disbursecommunity association funds must be covered by a fidelity bond or fidelity insurance if those funds at any time total more than 60,000.00. That coverage must be for an amount at least equal to three months' assessments due from all members of theassociation or associations managed plus any reserves that the association or associations require the broker to maintain. Ifthe firm currently provides such coverage, list coverage below:Institution Name:Bond or PolicyNumber:GREC OPEN A FIRM 01.2021Page 3 of 6Reset FormPrint Form
Georgia Real Estate CommissionGeorgia Real Estate Appraisers BoardSection D229 Peachtree Street NESuite 1000 - International TowerAtlanta, GA 30303-1605Phone: 404-656-3916Email: [email protected] InformationFailure to disclose any conviction, nolo contendere plea, or first offender sentence to a criminal offense, isgrounds for denial of your license. Additional information about the Background Clearance is located on thewebsite at www.grec.state.ga.us.(1) Has this firm previously held a Georgia real estate license?IF YES:YESFirm Name:Firm License #:NO(2) In Georgia, or any other state, jurisdiction, or country, has the Broker or Qualifying Broker, any owner, member, officer, director or stockholderof this Firm ever been convicted of, pled nolo contendere to, or been granted first offender treatment upon being charged with (1) a criminal offenseother than a traffic violation or (2) driving under the influence (DUI) of alcohol or drugs?YESNOYou must answer YES to this question even if:(a) you have been pardoned for the criminal offense;(b) anyone (lawyer, teacher, broker, government official, etc.) has told you that: (1) the offense is not, or is no longer 'on record', (2) theoffense has been expunged from your record, or (3) you do not have to disclose the offense, (4) your civil and political rights have beenrestored, or (5) any similar statement that appears to suggest your 'record' has been cleared; or(c) the conviction is not reported by the Georgia Crime Information Center (GCIC) or the National Crime Information Center (NCIC).If YES, you must include the following documents with this application, UNLESS you have already submitted them tothis agency:(A) For every occurrence (with the exception of a single DUI), provide a certified copy of the citation, accusation, or indictment that ledto the conviction AND a certified copy of the sentence / final disposition. If the court disposition is unavailable, provide a letter fromthe court stating the documents are not available.(B) For every occurrence (including that of a single DUI) provide a detailed written statement that includes:1) an explanation of the circumstances surrounding every conviction2) whether you have made any required restitution3) whether you have completed all conditions of your sentence4) whether you are on parole or probation (and the date it will end)(3) Has the Broker or Qualifying Broker, any owner, member, officer, director or stockholder of this Firm ever been disciplined by the Georgia RealEstate Commission or the Georgia Real Estate Appraisers Board?YESNO(4) Has the Broker or Qualifying Broker, any owner, member, officer, director or stockholder of this Firm ever been disciplined by any other state orfederal licensing agency or authority which regulates any profession? (Disciplinary actions include, but are not limited to, such actions as: areprimand, a suspension, a revocation, a fine, or any restriction placed on a license.)NOYESIf you answered "YES" to question (4), you must include the following documents with this application, UNLESS you havealready submitted them to this agency:(A) For every occurrence, provide a certified copy of the final order from the licensing agency that imposed the disciplinary action.(B) Provide a detailed written statement that includes:1) an explanation of the circumstances surrounding the disciplinary action2) whether you have made any required payment3) whether you have completed all conditions of your disciplinary action4) whether your license is currently suspended or revokedGREC OPEN A FIRM 01.2021Page 4 of 6Reset FormPrint Form
Georgia Real Estate CommissionGeorgia Real Estate Appraisers BoardSection E229 Peachtree Street NESuite 1000 - International TowerAtlanta, GA 30303-1605Phone: 404-656-3916Email: [email protected] Applicants must sign Part #1 below. Only applicants for a Partnership, Corporation, or Limited LiabilityCompany must complete Parts #2 and 3.(1) I hereby agree that, by law, if applying for Partnership, Limited Liability Company, or Corporation, the qualifying broker is apartner (if partnership), a member or the manager (if LLC), or an officer (if a corporation); or if applying for a sole proprietorship thebroker is the only one with an ownership interest in the firm. In addition, I agree that the qualifying broker, as required by law, isauthorized by the firm to bind it to any settlement of a contested case before the Commission as defined in Chapter 13 of Title 50,the "Georgia Administrative Procedure," in which the firm may be named Respondent.I hereby irrevocably consent that, if any cause of action arises against me or arising from my acts or omissions as a real estatelicensee within the state of Georgia and if at the time I am not a resident of the state of Georgia, suit may be commenced againstme in the county in the state of Georgia in which said cause of action may arise, or in which the plaintiff may reside, by the serviceof process upon the Real Estate Commissioner of the Georgia Real Estate Commission, whom I hereby designate for suchservice; and I further consent that such service shall be begun and held in all courts to be as valid and binding as if due service hadbeen legally made upon me in the state of Georgia.I hereby authorize a representative of the Georgia Real Estate Commission to periodically obtain and receive any criminal historyrecord information and/or full lifetime driver history record information pertaining to me which may be in the files of any federal,state, or local criminal justice agency.I hereby agree that if I am or become a nonresident of the state of Georgia, I will cooperate with any investigation initiated inaccordance with the Official Code of Georgia Annotated §43-40-27 by promptly supplying any documents that any authorizedinvestigator of the Commission may request and by personally appearing at the Commission offices or other location in Georgia asthe Commission investigator may request.I hereby authorize the Commission to examine any of the firm’s real estate escrow / trust accounts at such times as it may directand certify that I have signatory powers on all of the firm’s real estate escrow / trust accounts.I hereby certify the information provided in this application is true to the best of my knowledge and belief.DateBroker's Signature(2) If the firm is a corporation, a limited liability company, or a partnership, you must supply the full name and complete residenceaddress for all officers, members and managers, or partners.List Names and Address ( attach additional pages if necessary)GREC OPEN A FIRM 01.2021Page 5 of 6Reset FormPrint Form
Georgia Real Estate CommissionGeorgia Real Estate Appraisers Board229 Peachtree Street NESuite 1000 - International TowerAtlanta, GA 30303-1605Phone: 404-656-3916Email: [email protected](3) If the firm is a partnership, a limited liability company, or a corporation, the affidavit below must be completed and signed by thequalifying broker. The broker signature must be notarized.AFFIDAVITCounty ofState ofPersonally appearing before the undersigned, a notary public in and for said State and County:, who on oath says that he or she is a(Partner, Officer, Member or Manager)(Name of Affiant)of(Name of Partnership, Corporation, or LLC), named in the foregoing Consent to Jurisdiction and in theapplication for the license to which it is attached; and that he or she is duly authorized by saidto execute said consent.(Partnership, Corporation, or LLC)(Affiant's Signature)Sworn and subscribed before me this, 20, day ofMy Commission Expires:(Notary Public - signature and seal must appear on form)GREC OPEN A FIRM 01.2021Page 6 of 6Reset FormPrint Form
Georgia Real Estate Commission Georgia Real Estate Appraisers Board. Email: [email protected] Corporation- attach a . LLC- attach a . Certificate of Authority* *Obtain from the Georgia Secretary of State's office. This form can be filled out on-line. Print TWO copies: one to sign and submit for processing and one for your records.