Get My Commission Application

About The Agent
Location

Texas Other
Agent Name

First Name Last Name
Cell Phone Number

Area Code Phone Number
Email
example@example.com
Real Estate License Number
Your Business Is Operated As A:

LLC S-CORP Sole Proprietorship Limited Partnership
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Do You Own or Rent Your Home

Rent Own
Real Estate Company Name
Real Estate Company Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Real Estate Company Phone Number

Area Code Phone Number
Broker/Auth Rep Name
Broker/Auth Rep Email
Years With This Company
Year Licensed
Total Income Last Year
Number of Escrows Pending
Number of Transactions Closed
Number of Current Listings
Have You Ever Filed for Bankruptcy

No Yes
About the Property

Agent hereby offers to sell to Get My Commission, the “Commission” described below.Contract Information: (The “Contract”)
Property Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Buyer(s) Name(s)
Seller(s) Name(s)
Escrow/Title Co.
Escrow/Title Co. Phone Number

Area Code Phone Number
Escrow/Title Co. Officer Name
Escrow/Title Co. Officer Email
Escrow/Title Co. Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Property Sale Type

Conventional Owner Financed FHA/VA Fannie Mae/Freddie Mack Cash
Earnest Deposit
Down Payment
Final Contract Price
Settlement Date

Month Day Year
Date
Escrow Reference Number (if available)
Commission Information: (The "Commission")
Receivable (Agent’s share of Commission after ALL expenses and deductions): Dollar Amount
How much of your Commission would you like to receive in your bank account? Dollar Amount
Total Commission Expected To Brokerage
% Commission Expected To Brokerage
Transaction Representation

Listing Agent Selling Agent Both
Do you currently have any open advances with other commission advance companies?

No Yes
Are you a first time client?

Yes No
Additional User Information
How did you hear about us?

Search Engine Referral Email Marketing Other
Submission Date

Month Day Year
Date
If your advance is approved, please provide the following information for where we should send your funds:
Bank:
Account Number:
Routing Number:
Should be Empty:

About The Agent

About the Property

Commission Information: (The "Commission")