Sales Rep. Name:

Listing Agent:    Phone:   Fax:   Comm: (%)

Selling Agent:    Phone:   Fax:   Comm: (%)

Property Address:    County:

Tax ID # / Folio #:   

Order Termite?   Order Survey?   Closing Date:

Who is holding Buyers deposit?    Deposit Amount:

Buyer's Names:     Marital Status:

Buyer's Address:

Buyer's Phone Numbers:  Work: Home: Cell:

Will this be a mail away?:   His Social:   Her Social:

Seller's Names:   Marital Status:

Seller's Address:

Seller's Phone Numbers: Work:   Home:   Cell:

Will this be a mail away?:   His Social:   Her Social: 

Loan Amount:   Conv:   2nd: 

Mortgage Payoff #1  Name:    Account #:

                                 Phone:                 Amount $:

Mortgage Payoff #2 Name:     Account#:

                                 Phone:                 Amount $:

Homeowner's Association Phone:    Amount of Assessments:

Insurance Agent Name: Phone:

Is Buyer or Seller purchasing a Home Warranty?   Cost: