Broker License Application


The application fee is non-refundable.
Choose one (determined by the physical location of your personal primary residence):	Resident - I currently live in North Dakota.
	Reciprocal - I currently live in and have a current real estate license in Minnesota, Iowa or Georgia with a firm and broker that have or will obtain a North Dakota firm and broker license.
	Non-Resident - I currently live in a state other than North Dakota and have a current real estate license in the state in which I live.
	State in which you live:


Do you conduct licensed real estate business with a firm and broker that has or will obtain a North Dakota firm and broker license?	Yes	No
Name of firm and broker:
Please upload your individual certificate of licensure (COL) from your state of residence. COL must be dated within 30 days of application submission, and must include a section on disciplinary status. Click here for recommendations on uploading files.
Please upload certificate of license (COL) from MN, IA or GA. COL must be dated within 30 days of application submission, and must include a section on disciplinary status. Click here for recommendations on uploading files.


Did you previously pay the fee of $20 into the North Dakota Real Estate Education, Research, and Recovery Fund (NDCC 43-23.2-02)?	Yes	No


Do you currently have plans to change your primary residence to a different state?	Yes	No

Personal Information


First Name:	Middle Name:	Last Name:	Suffix:
Place of Birth:		Social Security Number:	Date of Birth:
List City, State and if not the United States, then list the Country.


I, the applicant, intend to operate as:	A Designated Broker/Officer for Corporation
	A Designated Broker/Officer for Limited Liability Company
	A Designated Broker/Officer for Partnership
	A Designated Broker for a Sole Proprietorship
	An Associate Broker supervised by another Broker


Name of Corporation:
Name of Limited Liability Company:
Name of Partnership:
What is the name of Sole Proprietorship:
Do you have a DBA?	Yes	No
Trade Name:			Must be exactly as name appears on legal documents.
Please upload a copy of the Certificate of Registration for the trade name from the North Dakota Secretary of State. Click here for recommendations on uploading files.


Name of Employing Firm:
Street Address:
City:	State:	ZIP Code:


Do you have a broker trust account?	Yes	No
Do you intend to have a broker trust account?	Yes	No


Name of Bank:	Name of Account:	Address:	City:	State:	ZIP Code:


Please download and complete the Consent to Examine Trust Account. Then upload using the button below. Click here for recommendations on uploading files.
Please download and complete the Request a Waiver of Trust Account. Then upload using the button below. Click here for recommendations on uploading files.