License Record Request Form

In order to complete your request, you must provide at a minimum, either:

Name, mailing address, and phone number (in case we have questions about your request); OR
Valid Email Address

Contact Information

Your Name*

Your Address*

City*

State*

Zip*

Phone*

Fax

Email*

Record Requested

Information contained in our records will be provided to you via Regular United States mail or it will be transmitted electronically if an email address if provided.

In order to provide an accurate response about the person or entity for whom you are seeking information, the Division needs as much information about the person or firm as possible. For example, if you are seeking information about whether John Doe has a securities salesperson's license in Ohio, we need more than "John Doe" and "Ohio" because there are hundreds of John Doe's in Ohio.

Therefore, please state the entire legal name, including middle initial, if known of the natural person on whom you are seeking information, OR the complete legal name of the entity on which you are seeking information.

Name

Also, include the location of the person or entity relative to city and state:

City

State

If known, include information such as the person's:

CRD Number

Street Address

The employing firm the person represents

Other

Specific Request Please check any/all that apply

Please note any other questions or comments relevant to this Record Request

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