GOVERNMENT OF THE DISTRICT OF COLUMBIA
Department of Consumer and Regulatory Affairs
Business and Professional Licensing Administration
ESCROW ACCOUNT INFORMATION
The D.C. Real Estate Licensure Act of 1982 as amended requires that you notify the Board of Real Estate
of certain information relative to your escrow account, in addition to an authorization for the Board to
review the account at any time it directs.
Please complete the following form, therefore, advising the Board, of all current escrow accounts.
Information is also to be provided to the Board on accounts opened and closed in the future. You may
wish to duplicate this for future use. It is suggested that you retain copies of all completed forms for your
records. Once the form is completed, have it notarized and return it to:
Pearson VUE/DC Board of Real Estate
8201 Corporate Drive
Suite 400
Landover, MD 20785
………………………………………………
ESCROW ACCOUNT REPORTING FORM
LICENSEE’S NAME LICENSE #
BROKER’S NAME
BUSINESS ADDRESS PHONE #
ESCROW ACCT. NAME ACCT.#
NAME OF FINANCIAL INSTITUTION
ADDRESS OF FINANCIAL INSTITUTION
ESCROW ACCT. NAME ACCT.#
NAME OF FINANCIAL INSTITUTION
ADDRESS OF FINANCIAL INSTITUTION
I certify the above information is correct, and I authorize the above financial institution(s) to allow the
D.C. Board of Real Estate (or its authorized agent) to examine all books, records and contracts relating to
the account(s) cited above. Such examination may be made at any time directed by the D.C. Board of
Real Estate.
DATE AUTHORIZED SIGNATURE
Subscribed and sworn to before me this day of 20 .
NOTARY SEAL _
SIGNATURE OF NOTARY PUBLIC