Branch Office Application Form. This is a Ohio form and can be use in Department Of Commerce Statewide.
Tags: Branch Office Application, COM 3608, Ohio Statewide, Department Of Commerce
Ohio Department of Commerce Division of Real Estate & Professional Licensing Governor 77 South High Street • 20th Floor Columbus, OH 43215-6133 (614) 466-4100 FAX (614) 644-0584 www.com.ohio.gov REAL ESTATE . Director BRANCH OFFICE APPLICATION This form is interactive. You may, before printing, type your responses FOR DIVISION USE ONLY FEE AMOUNT BROKER NUMBER directly onto the form. Otherwise, this form must be typewritten or printed legibly in black ink. FILE NUMBER ISSUE DATE Incomplete applications and applications that are filled out incorrectly will be returned for correction. A check or money, made payable to the Ohio Division of Real Estate, in the amount of $8.00, must accompany each application. Cash will not be accepted. A separate application is required for each branch office. To change a branch office address, please use the Change Application. APPLICANT INFORMATION NAME OF APPLICANT/COMPANY DOING BUSINESS AS (D.B.A.) NAME FEDERAL TAX ID NUMBER MAIN BUSINESS ADDRESS BUSINESS PHONE ( CITY STATE ) ZIP CODE + 4 BRANCH OFFICE INFORMATION NAME OF PERSON IN CHARGE OF BRANCH OFFICE FILE NUMBER BRANCH PHONE ( BRANCH OFFICE ADDRESS CITY STATE ) ZIP CODE + 4 THE APPLICANT MUST COMPLETE THE FOLLOWING CERTIFICATION I certify that all of the statements on this application and all of the attached materials are complete and accurate. I understand that any false statement on this form or any of the attached materials may subject me to criminal prosecution and the loss of my Ohio real estate license. __________________________________________________ ___________________________________ _______________ NAME OF THE INDIVIDUAL AUTORIZED TO BIND THE ABOVE NAMED APPLICANT SIGNATURE DATE FINANCIAL INSTITUTIONS INDUSTRIAL COMPLIANCE LABOR & WORKER SAFETY LIQUOR CONTROL REAL ESTATE & PROFESSIONAL LICENSING SECURITIES STATE FIRE MARSHAL UNCLAIMED FUNDS COM 3608 (Rev. 11-2004) “An Equal Opportunity Employer and Service Provider” Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com