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Laurie R. Stegall
Brian Clifford
Nick Canovai
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Buyers/Selling Agent Request Form
(to be filled out by Selling/Buyer’s Agent)
"
*
" indicates required fields
Closing Date:
MM slash DD slash YYYY
Agent's Name:
*
Property Address:
*
Best contact information for agent:
Agent's Phone
*
Agent's Email
*
Mailing address:
Do you have an assistant that can help if you are unavailable?
*
Yes
No
Assistant's Name
Assistant's Phone
Assistant's Email
What is your expected commission? (%)
Please enter a number from
0
to
100
.
What is your expected commission? ($)
Are there any other fees payable to your firm?
Yes
No
Amount
Reason/Name
Put on Seller or Buyer side?
Seller
Buyer
Amount
Reason/Name
Put on Seller or Buyer side?
Seller
Buyer
Due to new requirements, it is critical that we are provided with all invoices ASAP. Failure to timely provide them may result in invoices being rejected for payment at closing (POC).
Please list below amounts to be paid and to whom and provide invoices.
Service
Are you getting a survey of the property?
*
Yes
No
If Yes, should we order a survey for you?
*
Yes
No
Pest Inspection
Pest Inspection
Paid
Due
Put on Seller or Buyer side?
Put on Seller or Buyer side?
Seller
Buyer
Home Inspection
Home Inspection
Paid
Due
Put on Seller or Buyer side?
Put on Seller or Buyer side?
Seller
Buyer
Survey
Survey
Paid
Due
Put on Seller or Buyer side?
Put on Seller or Buyer side?
Seller
Buyer
Water Test
Water Test
Paid
Due
Put on Seller or Buyer side?
Put on Seller or Buyer side?
Seller
Buyer
Foundation Inspection
Foundation Inspection
Paid
Due
Put on Seller or Buyer side?
Put on Seller or Buyer side?
Seller
Buyer
Chimney Inspection
Chimney Inspection
Paid
Due
Put on Seller or Buyer side?
Put on Seller or Buyer side?
Seller
Buyer
Home Warranty
Home Warranty
Paid
Due
Put on Seller or Buyer side?
Put on Seller or Buyer side?
Seller
Buyer
Other
Other
Paid
Due
Put on Seller or Buyer side?
Put on Seller or Buyer side?
Seller
Buyer
Other
Other
Paid
Due
Put on Seller or Buyer side?
Put on Seller or Buyer side?
Seller
Buyer
*****Please upload all invoices, paid or unpaid******
(Please also send a copy of pest inspection/WDIR Report & signature page)
Drop files here or
Select files
Max. file size: 15 MB.
Upload Your Client's Government-Issued ID
Max. file size: 15 MB.
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