Unlicensed Real Estate Activity Report Form
Reporting Party Information
(optional if submitting anonymously)
Name:
Company (if applicable):
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Preferred Method of Contact:
Phone
Email
None (Anonymous)
Business or Individual Being Reported
Business / Individual Name:
*
Owner / Manager Name (if known):
Business Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (if known):
Format: (000) 000-0000.
Website or Online Listing Link:
*
Social media profiles used for advertising:
Type of activity being reported (check all that apply):
*
Representing buyers or sellers in the sale of a business
Marketing a business for sale
Soliciting buyers for a business
Negotiating deal terms between buyer and seller
Holding themselves out as a broker, intermediary, advisor, or agent
Receiving or requesting compensation tied to a business sale
Other
Basis for belief that activity is unlicensed (check all that apply):
*
No active Florida license found in DBPR records
Individual admitted they are not licensed
License number not disclosed when required
Operating under another license that does not permit brokerage activity
Other
How did you become aware of this activity (check one):
*
Direct involvement as buyer or seller
Competing broker
Public advertisement or listing
Referral or third-party communication
Other
Evidence available (check all that apply):
*
Advertisements or listings
Emails or written communications
Contracts or fee agreements
Invoices or proof of compensation
Screenshots or recordings
Witness statements
Other
Detailed description of the activity:
*
Please include dates, names, how the activity occurred, and any supporting facts
Impact (optional) (check all that apply):
Financial loss or risk to a buyer or seller
Misrepresentation of credentials
False or misleading deal representations
Paying a fee to someone who has no legal authority
Other
Signature (optional):
I declare that the information provided is true and accurate to the best of my knowledge.
Date:
-
Month
-
Day
Year
Submit
Should be Empty: