Request BROKER Name Change
And/Or Request To Replace BROKER License/Pocket Card

An image of the North Carolin Real Estate Seal.

The Real Estate Commission can issue a real estate license certificate and/or pocket card only if the original license or card has been lost, damaged, or was never received, or if the name of the licensee has been legally changed (either by reason of marriage or otherwise). To have a real estate License and/or pocket card reissued, please provide the following information. Forms not properly completed cannot be processed.
This form should only be used to request a BROKER name change. To request a firm name change, please use the Request FIRM Name Change and/or Request to Replace FIRM License Certificate or Pocket Card.
Online payments to the North Carolina Real Estate Commission may be made securely, quickly, and easily. Upon submission of this web-form you will be redirected to our online payment service provider, PayPal.
Payment may be made with a Visa, MasterCard, American Express, Discover, or valid PayPal account.
All fees are non-refundable.

Request Type

I hereby certify to the North Carolina Real Estate Commission that [check all appropriate option(s)]: *

My real estate license pocket card has been lost or damaged, and I request a paper replacement. ($5 fee required).

My real estate license certificate has been lost or damaged, and I request a replacement ($5 fee required).

My real estate license certificate was never received, and I request a replacement (Only select this option if your request is within 45 days of license issuance).

My name was legally changed.(fee required).

Date your name was legally changed*

Previous first name:*

Previous middle name:*

Previous last name:*

Current first name:*

Current middle name:*

Current last name:*

What is the reason for your legal name change?*

Please give the reason for the name change.*
If your name has been changed for reasons other than marital status include a copy of the legal document showing the name change in the document upload section below.

Please select your preferred option*

Please send me an updated license certificate ($5 fee required). I will download an updated digital pocket card (at no charge) once my name change has been processed.

Please send me an updated license certificate ($5 fee required) and an updated paper pocket card ($5 fee required).

Licensing Information

License Number*

First Name*

Middle Name*

Last Name*

Physical Address*

City*

State*

9-Digit Zipcode Lookup*

Mailing Address

City

State

9-Digit Zipcode Lookup

Is this a new address?*

Public Phone

Private Phone*

Public Email

Private Email*

Document Upload

If your name has been changed, please upload any supporting documentation, such as a court order or divorce decree, showing the name change. If your name has changed as a result of marriage, please provide a marriage certificate with a copy of your driver’s license or other state ID that shows the new name. [A marriage certificate alone is not sufficient.]
*Accepted File Types: .tiff .tif .jpeg .jpg .txt .pdf .docx .doc .png
*Max file upload size 10MBs.

Signature and Certification

Signature Required*

(Type your name)

Date Signed

11/17/2024

You must complete the reCaptcha below before submitting this form*

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3.128.197.55

This form is not meant to be printed. If you have already completed the form please use the submit button at the bottom to send the form directly to the Commission.

Request BROKER Name ChangeAnd/Or Request To Replace BROKER License/Pocket Card

Request BROKER Name Change
And/Or Request To Replace BROKER License/Pocket Card