Listing Mutual Release Request Form

MOMENTS REAL ESTATE

1301 N Gravel Pike, Perkiomenville, PA 18074

www.moments.realestate

(215) 237-7660
MUTUAL RELEASE REQUEST FORM:

IMPORTANT: Please notify your co-op agent about the release now if you have no already.
Agent Name*

First NameLast Name
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Client #1 Name*

First NameLast Name
Client #2 Name

First NameLast Name
Who are we representing?*

BuyerSellerBoth
Is this release being requested during a contingency period?*

InspectionAppraisalNoOther
How should we handle the EMD?*

Refund to Client - Send Authorization FormHold in EscrowEMD Not Processed YetSee Additional Comments
For Refund Only: Which client should be sent the authorization form (if applicable)

Client #1Client #2
Please provide a detailed reason for requesting the release.*
Example: Found mild during inspection and seller won't negotiate. (Bad inspection is too vague, please specify.)
What actions were taken prior to requesting a release?*
Additional Comments
Mutual Release Acknowledgement: I understand that the EMD cannot be released or put towards another purchase until a fully executed release form is received by the transactions team. I also understand that an EMD refund with Moments Real Estate can take up to 7 business days from the receipt of a fully executed mutual release and refund authorization form to process.
Should be Empty: