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Agent/Office Transfer Form

License must be terminated before December 31 to avoid annual dues billing for the following year.

Assistant to agent must also be terminated (if any)

Fields marked with an * are required.

Date of Transfer *

Company Name *

Company NRDS ID *

Broker First Name *

Broker Last Name *

Member First Name *

Member Last Name *

Member NRDS ID *

NEW TREC LICENSE (attach) *

20MB max

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