Agent Form

PROPERTY ADDRESS:

I am

Agent Type—Please choose an option—Listing AgentSelling Agent

Company Address

Email ^*

Cell

schedule settlement for

at

Closing Location

Buyers AgentNone2.02.52.753.03.5

Listing AgentNone2.02.52.753.03.5

Buyers Agent Flat FeesNone250295345350395450

Listing Agent Flat FeesNone250295345350395450

Reimbursements or bills to pay?

Seller Credits?

Home Warranty?—Please choose an option—NoYes

EMD: Is to be WIRED on

and will be held by:—Please choose an option—Selling AgentMBO Settlements

Email

Email 2

Phone Numbers

Phone Numbers 2

Name

Loan Officer

Loan Officer Phone

Loan Officer email

Sellers Email

Sellers Email 2

Sellers Phone

Sellers Phone 2

Sellers are both expected to attend settlementYesNo

Is property tenant occupied or subject toTOPA?YesNo

Is property owner occupied?YesNo