Listing Agent Information Form The purchaser(s) have selected our company to conduct the settlement in connection with the sale of your property. As settlement agents, we are responsible for paying off and releasing any and all existing liens against the property, notifying any homeowners association and paying any outstanding dues, conducting the settlement, and forwarding proof of this transaction to the Internal Service Revenue. Seller Name* First Last Email* Second Seller (if applicable) First Last Subject Property Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Existing Lender #1 Account No PhoneExisting Lender #2 Account No PhoneHomeowner Assoc. Mgmt. Co. PhoneIs there a 2nd HOA? Yes No PhoneSeller Forwarding Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Social Security/EIN Numbers: Seller #1 Social Security/EIN Numbers: Seller #2 Marital Status: Seller #1Husband and WifeMarriedUnmarriedDivorced and not remarriedWidowedMarital Status: Seller #2Husband and WifeMarriedUnmarriedDivorced and not remarriedWidowedAre you purchasing a home within 24-48 hours of selling this property? Yes No Is there a need for an Assignment of Funds? Yes No If yes, provide contact name & number of title company or attorney Termite Inspection Ordered With PhoneWell and Septic Inspection Ordered With PhoneIs there a need for a Power of Attorney? Yes No If yes, please contact our office immediately as we will need additional information. Commission Breakdown: Selling % Listing % Admin/Processing Fees: $ Termite Co. Homeowner Warranty Yes No HMS/2-10: $ REIMBURSE LISTING AGENT:HOA Docs $ Invoices: $ (Please provide copies)Documents Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, pdf, doc, docx, xlsx, xls, csv, Max. file size: 50 MB. Notes - in case any additional information is required (i.e., 3rd seller, property in a trust, etc.)Would you like to add a Second SellerNoYesSecond SellerSeller Name First Last Subject Property Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Existing Lender #1 Account No PhoneExisting Lender #2 Account No PhoneHomeowner Assoc. Mgmt. Co. Is there a 2nd HOA? Yes No PhoneSeller Forwarding Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Social Security/EIN Numbers: Seller #1 Social Security/EIN Numbers: Seller #2 Marital Status: Seller #1Husband and WifeMarriedUnmarriedDivorced and not remarriedWidowedMarital Status: Seller #2Husband and WifeMarriedUnmarriedDivorced and not remarriedWidowedAre you purchasing a home within 24-48 hours of selling this property? Yes No Is there a need for an Assignment of Funds? Yes No If yes, provide contact name & number of title company or attorney Termite Inspection Ordered With PhoneWell and Septic Inspection Ordered With PhoneIs there a need for a Power of Attorney? Yes No If yes, please contact our office immediately as we will need additional information. Commission Breakdown: Selling % Listing % Admin/Processing Fees: $ Termite Co. Homeowner Warranty Yes No HMS/2-10: $ REIMBURSE LISTING AGENT:HOA Docs $ Invoices: $ (Please provide copies)Documents Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, pdf, doc, docx, xlsx, xls, csv, Max. file size: 50 MB. NameThis field is for validation purposes and should be left unchanged.