Follow the steps to complete the disassociation request form successfully.

1. Click the 'Get Form' button to access the disassociation request form and open it in your browser.
2. Fill out Section 1 with the required details: enter the name of the business as it appears on CSLB records, business mailing address, and license number. Make sure to include the city, state, and zip code. Also, provide the name and daytime phone number of the person disassociating.
3. In the same section, provide the mailing address of the person disassociating. Again, include the number/street or P.O. box, city, state, and zip code.
4. Specify the date of disassociation in the provided field in Section 1.
5. Proceed to Section 2. Enter the date, city, county, and state where you are certifying the information.
6. Read the certification statement carefully. By signing, you certify the accuracy of the information provided. Sign the form as the disassociating contractor, and print your name below your signature.
7. If applicable, indicate your license number to request the reactivation application for your individual license.
8. After completing the form, review all data for accuracy before submitting.
9. Once reviewed, you can save changes, download, and print the completed form for your records.
10. Finally, submit the form electronically as instructed, ensuring it is sent within the required time frame.

Complete your disassociation request online today to ensure compliance and timely processing.