45-DAY PERMIT SPONSOR CARD
ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
Division of Professional Regulation/Real Estate Professions Section 320 West Washington Street, 3rd Floor
Springfield, Illinois 62786
Real Estate Licensing 217/782-3414
45-DAY PERMIT SPONSOR CARD
If you will be self-sponsored you must complete the 45-day permit on your own behalf.
This form is required to be completed in order to apply for licensure as a Broker, Managing Broker, or Leasing Agent.
You must include original terminated license or an affidavit explaining why the original license is not available.
This form is also required to change your Sponsoring Broker. When changing your Sponsoring Broker, there is a $25 fee. Payment must be in the form of a check or money order made payable to IDFPR.
|
|
|
EMPLOYEE INFORMATION |
(Note: Must be submitted within 24 hours of Issuance) |
CURRENT DATE _________________________ |
LICENSE NO. ____________________ |
NAME ___________________________________________SOC SEC NO._____________________ |
MAILING ADDRESS ________________________________________________________________ |
CITY, COUNTY, STATE, ZIP CODE |
___________________________________________________ |
TELEPHONE NUMBER ( _ _ _ ) _ _ _ - _ _ _ _ |
GENDER ___________________ |
SPONSOR/FIRM INFORMATION
SPONSOR NAME ___________________________________ LICENSE NO. ___________________
D/B/A (IF APPLICABLE) ______________________________________________________________
MAILING ADDRESS _________________________________________________________________
CITY, STATE, ZIP CODE |
_____________________________________________________________ |
TELEPHONE NUMBER |
( _ _ _ ) _ _ _ - _ _ _ _ |
BY __________________________________________________ LICENSE NO. _________________
MANAGING BROKER SIGNATURE
Retain two copies, one for the sponsor and one for the employee.
If you have any questions, please contact our office.
Return Original to the address at the top of this form.
320WEST WASHINGTON STREET SPRINGFIELD, ILLINOIS 62786 PHONE: 217-785-9300 FAX: 217-782-3390 TDD: 217-524-6644 http://www.idfpr.com
IL 505-0345 (Revised 05/2012)