Agent Transfer/Release Form
Fill out the agent name and information below
Name
*
First Name
Last Name
Name of the person filling out this form
First Name
Last Name
Email of the person filling out this form
*
example@example.com
License #
*
Choose one
*
Transfer this agent to another brokerage
Delete the agent named above - I have returned the license to DPOR
Transfer this agent into my brokerage
Transfer this agent from
*
Brokerage Name even if deleting the agent
Transfer this agent to
Brokerage Name and Branch Office if Applicable
Please change the agent's email to
example@example.com
Effective Date
*
-
Month
-
Day
Year
Date
BROKER’S CERTIFICATION (Required):I agree that as a licensee of my firm I am responsible for this agent's dues if they are transferring into my firm. Signature is also required if deleting an agent or outgoing transfer.
Submit
Should be Empty: