Pay at the Table Form

Pay at the Table Form

Please complete all sections
Did you submit your Dotloop file for review and was it approved? (If NO, please submit loop for review and approval prior to completing this form.)*
Is Closing Occurring within the next 7 Days? If No, please wait until 7 Days prior to Closing to Submit Your Request*
What is the effective ratification date of your agreement of sale?

MonthDayYear
Date
Is the sale for a buy side transaction where the buyer is financing with a VA Loan? *
Agent Name*
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Buyer / Seller Name
Purchase Price*
Cooperating Commission*

.5%1.0%1.25%1.5%1.75%2.0%2.25%2.5%2.75%3.0%3.25%3.5%3.75%4.0%4.5%5.0%5.5%6.0%
Date of closing*

MonthDayYear
Date
Commission Disbursement
Agent Compensation Plan / Team Split*

5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%90%100%
Outside Referral Percentage

20%25%30%35%
Broker Transaction Fee Due = *
What is the amount that the client is paying for the broker transaction fee?
What is the amount that the buyer / seller are paying towards the broker transaction fee *
Gross Commission
Outside Referral Fee Amount
Who Should the Referral Check be made Payable to?
Referral Check Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Collected Broker Transaction Fee from Client
Attorney's Office Performing The Closing *
Outstanding Broker Transaction Fee Due to Iron Valley Real Estate
Phone Number
Please enter a valid phone number.
Amount to be paid to Agent at Settlement
Agent Email*
example@example.com
DO YOUR NEED AN ESCROW CHECK?*
ESCROW CHECK AMOUNT
When signed below, Iron Valley Real Estate at the Beach authorizes the total commission to be disbursed by separate check and delivered as indicated above. If for any reason the amounts on the checks are different from this letter of authorization YOU MUST OBTAIN NEW APPROVAL.

Sales associates are not authorized to modify commission agreements
Broker Authorization
Agent Name
Amount to be Paid at Table to Agent
Broker Transaction Fee Made Payable to Iron Valley Real Estate at the Beach - $395

Remaining Commission Payment Balance should be made payable to Iron Valley Real Estate at the Beach
Should be Empty:

Pay at the Table Form

Commission Disbursement