* fields are mandatory

Transaction Information

• Property Address:*
• Seller(s) Name:*

Broker’s Information

• Agent’s Name:
• Cell Phone:
• Work Number:
• Email Address:
• Commission Split: Listing %
• Commission Split: Selling %

Additional Information

• 1. Any Administrative Fee?
  Yes No
• Amount $
• 2. Any Selling Agent Bonus?
  Yes No
• Amount $
• 3. Any Home Warranty to be paid at closing?
  Yes No
• Amount $
• Paid by Seller or Buyer:
• Home Warranty Name:

Please bring Home Warranty Form to settlement if seller is paying for it.

• 4. Rent Back?
  Yes No
• How many days:
• Amount $
• Deposit Amount: $

  (if applicable)

• 5. Seller’s Credit to Buyers?
  Yes No
• Amount $

  or percentage:

  %
• 6. Any Additional Invoice(s)
  Yes No
• Amount $
• 7. Will your client be present at closing?
  Yes No
• If not, will your client be giving someone power of attorney?
  Yes No
• From:
• To whom:

For POAs, please ready the following:




Please contact out our office a soon as possible if you will be unable to attend closing and will be using a power of attorney. All power of attorney must comply with state law, title insurance, lender and Fannie Mae’s guidelines. To be absolutely certain that your POA is acceptable, please forward your “power of attorney” to our office for review prior to closing. The original power of attorney must be deliver to us at closing for recording with the County/District clerk.

• 8. Any Agent’s Credit?
  Yes No
• Amount $

  or percentage:

  %

If you do, please provide us a Broker’s authorization letter (MUST BE IN BROKER’S LETTERHEAD)

• Additional Comments: