Agent Form

• Property Address

• Seller(s)

  Seller Name(s)
• Seller Marital Status
• Social Security Number(s)
• If the Seller is a Corporation or LLC, please provide a resolution, Tax ID #, and the name of duly authorized representative
• Signing Agent/Representative and Title
• Seller’s Forwarding Address
• Seller’s Phone Number

• Existing Payoff Information:

  Please provide the lender(s), account number(s), and customer service phone number(s)

• Buyer(s)

  Buyer Name(s)
• Buyer Marital Status
• Social Security Number(s)
• Is the Buyer a Corporation or LLC? Yes No
• If the Buyer is a Corporation or LLC, please provide a resolution, Tax ID #, and the name of duly authorized representative. Tax ID # for LLC or Corp.
• Signing Agent/Representative and Title
• Buyer’s Forwarding Address
• Buyer’s Phone Number
• Sales Price
• Earnest Money Deposit
• Will EMD be brought to the closing? Yes No
• IF NO: withhold EMD from the check for Listing Agent or Selling Agent? Yes No

• Listing Agent

• Listing Agent
• Listing Company
• KY/IN Agent’s License #
• KY/IN Broker’s License #
• Listing Agent’s Phone
• Listing Agent’s Fax
• Listing Agent’s Email
• Commission % or $
• Based on
• Admin/Secured Doc. Fee

• Selling Agent

• Selling Agent
• Selling Company
• KY/IN Agent’s License #
• KY/IN Broker’s License #
• Selling Agent’s Phone
• Selling Agent’s Fax
• Selling Agent’s Email
• Commission % or $
• Based on
• Admin/Secured Doc. Fee
• Is the Seller paying any closing costs on behalf of the Buyer? Yes No
• If yes, how much?

• Additional Information

  Homeowner’s Association and Contact Information

  Note: If HOA information is provided by a third party, it is our policy to obtain the information and pass the third party’s cost directly to the seller(s).

• Termite
• Payable To
• Paid By Buyer/Seller POC/Collect
• Home Warranty
• Payable To
• Paid By Buyer/Seller POC/Collect
• Repairs
• Payable To
• Paid By Buyer/Seller POC/Collect

Owner’s Title Insurance will be included on the settlement statement unless otherwise advised.
We appreciate your business.