Change Form for Current Members

This form must be completed by the authorized office manager or broker.

Please indicate the change required

Delete - Leaving the business* Delete - Transfer to another REALTOR® Association* Delete - License Non-REALTOR®* Referral Agent* Change Info Reactivate Branch Office Office Transfer** For a Branch office there is a $25 transfer fee per member - max. of $250

Note: If you checked Referral Agent, please complete and submit the required Limited Function Referral Office Certification Form.
*Note: By signing below, if an agent is no longer sponsored by your office or becomes a referral agent, the broker accepts responsibility for the return of leased Lockbox equipment (if applicable.) In addition, please be sure to inform DCP, DCP.licenseservices@ct.gov, to avoid any non-dues assessments. (Per the GHAR bylaws Section X, 2a.) https://portal.ct.gov/DCP/License-Services-Division/All-License-Applications/Real-Estate-License-Change-of-Information.
**Note: By signing below, the new Broker/Office Manager accepts the transfer of responsibility of Member’s use of the eKEY and Lockbox equipment.

Member Information

First Name

Last Name

Date

Agent's Email Address

Cell Phone

Real Estate or Appraiser License number

Office Information

Office Name

Office Address

City

State

Zip

Office Phone

Member's Primary Association

GHAR Mid-State Tri-County Other

Please enter your primary association, if not listed above.

Payment
If you transferring to another office, please remember to submit your payment. Your transfer will not be processed until we have received payment. Complete the payment form and email it to ghar@gharonline.com.

This form must be signed by the authorized office manager or broker. Additionally, the broker is required to update this information on the Department of Consumer Protection’s website.

Broker's email

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