Buyer's Agent Information Form

Please confirm the correct spelling of your name:

Property Address:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Your Email Address:

Your Phone Number:

Selling Firm Name:

Selling Firm Mailing Address - Please confirm your firm's mailing address.

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

What commission is due to your firm on this transaction?

Other:

Does your brokerage get a single check for the entire commission or should we be receiving a commission disbursement authorization to split out your brokerage's check??

Are there any other fees due to your office?

Other:

Please Confirm Correct Spelling of Buyer's Name (sometimes contracts are not 100% legible when they reach us).

Buyer's Email Address:

Buyer's Phone Number:

If Buyer(s) are obtaining financing, please provide / confirm lender's contact information below.

Please confirm the expected closing date.

Will you be ordering a survey?

Other:

Please check if any of the following apply to your transaction.

Other:

Anything else you think we should know?

Enter the Characters Shown Below