RE 909 Credit Card Payment - California Department of Real Estate

S tate of C alifornia D epartment of R eal E state Real Estate MATTERS! C redit C ard P ayment RE 909 (Rev. 6/12) GENERAL INFORMATION Fees may be charged to your VISA, MasterCard, American Express, License Histories or Discover card. For certified license histories (license requirements for other states) or Credit card information must be mailed with appropriate forms. license history certifications (for legal purposes) complete the information requested below and mail to DRE with your Certified License History Original (sales, broker, or corporation) License Application Request (RE 293) or written request. Fee Complete the information requested below and mail to DRE with your Photocopies license application and supporting documents. For photocopy requests (certified & non-certified),

complete information Salesperson License Application (RE 202) below and mail to DRE with your Photocopy Request (RE 356B) or written Broker License Application (RE 200) request. Corporation License Application (RE 201) Subdivision Filings Renewal (sales, broker, or officer) Application Fee Complete the information requested below and mail with supporting Complete the information requested below and mail to DRE with your documents to the appropriate Subdivisions Office. Refer to Subdivision renewal application and supporting documents. Filing Fees (RE 605) for public report application filing fees. Salesperson Renewal Application (RE 209) Broker Renewal Application (RE 208) Education Course Approval Fee (CE & pre-license) Officer Renewal Application (RE 207) Complete the information requested below and mail to the Education Section with the appropriate course approval application and supporting documents. Forms and Fees Licensing forms and fee information can be obtained by mail from the Department of Real Estate’s Interactive Voice Response (IVR) system, which can be accessed by dialing 877-373-4542. Forms and a variety of Departmental information may also be obtained by accessing DRE’s Web site at www.dre.ca.gov. CREDIT CARD INFORMATION When charging fees to your VISA, MasterCard (MC), Discover Card (DSC), or Amercian Express (AE) the following information must be completed and submitted (with the appropriate form): METHOD OF PAYMENT (CHECK ONE) ACCOUNT NUMBER VISA MC DSC AE DRE Use Only EXPIRATION DATE AMOUNT AUTHORIZED ZIP CODE OF CARDHOLDER APPROVAL # $ CARDHOLDER NAME (PLEASE PRINT) APPLICANT/LICENSEE NAME (IF DIFFERENT, THAN CARDHOLDER) REFERENCE # PURPOSE OF TRANSACTION TRANSACTION DATE ORIGINAL LICENSE RENEWAL LICENSE EDUCATION COURSE APPROVAL MORTGAGE LOAN ADVERTISING SUBDIVISION FILING SUPPORT OBLIGOR FEE INITIALS _____________________________ LICENSING INFORMATION (IF APPLICABLE) SUBDIVIDER – DRE FILE # (IF KNOWN) SALESPERSON BROKER CORPORATION/OFFICER ID# ________________________________ SIGNATURE DATE CERTIFICATION I hereby certify that I PRINTED NAME (LAST, FIRST, & MIDDLE) DAYTIME TELEPHONE NUMBER understand that the fee remitted is deemed MAILING ADDRESS earned upon receipt. PRIVACY NOTICE: Section 1798.17 of the Civil Code requires this notice be provided when collecting personal or confidential information from individuals. Each individual has the right to review personal information maintained by this agency, unless access is exempted by law. Government Code Section 6162 and 6163 authorizes the maintenance of this information. All information is voluntary; however, failure to provide requested information may cause your credit card payment request to be delayed. The...

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