Pl Please visit our website at www.com.ohio.gov/real 614|466 - 4100 Fax: 614|644 - 0584 TTY/TDD: 800|750 - 0750 Anne M. Petit , Superintendent REAL ESTATE NAME RESERVATION APPLICATION - BUSINESS Reserve a business entity or doing business as (DBA) name for sixty days. Extend a prior name reservation for sixty more days. A check or money order for $10, made payable to the Ohio Division of Real Estate & Professional Licensing, must accompany this application. FEE: $10.00 FOR DIVISION USE ONLY FILE NUMBER The Division will research the name to determine compliance with Ohio Revised Code 4735.06(A). Notification of the results will be forwarded to the applicant within fourteen days. After receiving approval from the Division, contact the Ohio Secretary of Statme with that office. Note: The name reservation approval will expire after sixty (60) days. If the remainder of the business application process has not been completed within sixty (60) days, the name will be released. Submitting a name reservation for multiple DBAs does not necessarily permit you to use multiple DBAsapproval must be granted by the superintendent. Filing fee is $10 per filing. 1. APPLICAN FILE NUMBER FILE NUMBER ( I f applica b le) FEDERAL TAX I D NUMBER 2. CURRENT BUSIN ESS ENTITY NAME CURRENT BUS I NESS ENT I TY NA M E 3. NEW BUS I N ESS ENT I TY N A M E N E W BUSINESS EN TITY NAME 4. NEW FICTIT IOUS OR DBA NAME N E W F I CTITIOUS OR DOING BUSI N ESS A S (DB A ) N A ME 5. ADDITIONAL DBA DBA NAME 6 . CORRESPONDENCE A DDRESS (Where the d i v i s i on shou l d s e nd co rr espondence . ) STREET ADDRESS BUSINESS PHO N E C I TY COUN T Y STATE Z I P CODE 7 . PH Y SIC A L PL A C E OF BUSINESS A D DRESS (must be physically located in Ohio) STREET ADDRESS BUSINESS PHO N E C I TY COUN T Y STATE OH Z I P CODE 8 . FR A N CHISE? Are y ou associated w ith a real es t ate franchise? YES NO If Y ES, w h at is the franchise nam e ? 9 . Name of appl i c a nt o r principal b r oke r / o ff i ce r/ member/pa r tner a u thor i z ed to bind same. ( t y pe or pri n t) Signatu r e o f appl ic ant or principal b rok e r/ o ffice r /member/ p art n er a uthor i z ed to bind sa m e. Signature X: D ate SUPPLEMEN T A L INSTRUCTIONS FOR C O MPLETING B O XES 1 7 A B OVE BOX 1: FILE NUMBER: Enter the file number, if applicable. If applicant is unlicensed, leave blank. BOX 2: CURRENT BUSINESS ENTITY NAME: If changing an existing business entity name, enter current business entity name. If requesting a business entity name for a new business, leave this box blank. BOX 3: NEW BUSINESS ENTITY NAME: Enter new business entity name. If only adding or changing a fictitious or Doing Business As (DBA) name, leave this box blank. Do NOT include a franchise name in your business entity name request. BOX 4: NEW FICTITIOUS OR DBA NAME: Enter new fictitious or Doing Business As (DBA) name, if applicable. Do NOT include a franchise name in the DBA name request. BOX 5: ADDITIONAL DBA: If you wish to use multiple DBAs, enter the additional name here. Submit a separate application for each DBA. BOX 6: CORRESPONDENCE ADDRESS: Enter the address where the Division should send name reservation correspondence. BOX 7: PLACE OF BUSINESS ADDRESS: Enter the physical address of the business. *If you do not have a physical address at this time, enter the proposed city of the new company. Please note: Ohio law requires that Ohio licensed brokerages maintain a physical place of business in Ohio. BOX 8: FRANCHISE?: If your company is joining or is already associated with a real estate franchise, please enter the franchise name in this box. REPL-17-0006 COM 3044 Equal Opportunity Employer and Service Provider Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com