Your Info

Your Info (the person completing this form)

First Name *

Name of person completing this form

Last Name *

Name of person completing this form

Email *

Email of person completing this form

Phone *

Phone of person completing this form

Attach Contract

Attach a PDF of the contract if possible.

Property Info

Property Address

Address of property being sold

Property City

Property State

Property Zip Code

Tax ID

Seller Info

Seller's Full Name

Include middle initial

Seller Marital Status

Married

Single

Seller's Phone Number

Seller's Email Address

Seller's Current Home Address

Primary Seller Last 6 SSN

DO NOT add full SSN

Loan Info

Seller's Lender

For payoff

Buyer’s Lender

If any

Loan Amount

Loan Number

Sales Price

Earnest Money

Closing Date

Closing Info

Commission Due to Listing Agent from Seller

What is the Commission due to Listing Agent from Seller?

Seller Crediting Buyer’s Agent Commission?

Is the Seller crediting the Buyer’s Agent Commission, if so how much?

Commission Due from Buyer

If no Seller Credit what is the Commission due from Buyer?

Will all parties attend closing or do we need to plan for a mail away?

$150 coordination fee

Are there any inspections or home warranties that need to be on the Settlement Statement?

Are there any closing cost credits, repairs or other credits that need to be on the Settlement Statement?

Are there any side lots or back lots that are included and may have a separate tax ID#?

Any other information for the closing agent?

If this property is in an Estate, LLC, or Trust?

If yes additional information will be required from the parties.