Application For A New Broker/ Agent License, Renewal License And Change Of Information
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6APPLICATION FOR A NEW BROKER/ AGENT LICENSE,
RENEWAL LICENSE AND CHANGE OF INFORMATION
____________________________________________________________________________________________________________
Please email at:
Businessunit@tlc.nyc.gov
to schedule an appointment to submit your application and supporting documents.
th
rd
Completed application, required documentation and fees can be submitted in person at: 31-00 47
Avenue, 3
Floor, Long Island
City, NY 11101, between the hours of 8:00 am to 3:30 pm, Monday-Friday. Please visit our website for more information at:
or contact our Call Center at 718-391-5501. This form can be used to apply for a New Agent/Broker License,
Renewal License and Change of Information.
License Type:
License #:
Please enter current license#. If
Medallion Agent
application is for new base, a license #
will be assigned.
Medallion Broker
Purpose of this application:
Business Type:
Please check appropriate box(es) to indicate the type you
Please check appropriate box (check one only)
applying for:
Sole Proprietorship
New License Application
Partnership
Renewal License Application
Corporation
Change of Information
(Location, Name Change, Change of Owner,
Officers etc.)
LLC
I. BACKGROUND INFORMATION ON AGENT/BROKER
(All fields in this section must be filled-out completely for your application to be processed)
Name:
D/B/A:
Address:
City:
State:
Zip Code:
E-Mail:
(requiredl)
Website Address
(optional):
Business Phone #:
EIN#:
or
SSN#:
Proof of EIN / Social Security No. – If a corporation or partnership, you must submit
24 hour phone#:
an IRS issued 145-C letter/notice. If a sole proprietor, you must submit proof of social
security number.
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Agent / Broker New, Renew, Change of Information Application 11.16.15
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