Agent Contract Intake Form

Agent Contract Intake Form
Agent Name

NameLicense#
Co-Agent Name

NameLicense#
Brokerage

Name License#
Cell#
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Agent Represents
Cooperating agent

Name Brokerage
Cell#
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Client name

First NameLast Name
Client Email
example@example.com
Client cell phone
Please enter a valid phone number.Format: (000) 000-0000.
Client name

First NameLast Name
Client Email
example@example.com
Client cell phone
Please enter a valid phone number.Format: (000) 000-0000.
MLS#
Property Address

Street Address

Condo or Space number

CityState

Zip Code
Sales Price
EMD Amount
Contract Effective Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Closing Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Home Warranty
Warranty CompanyContact person
Warranty Company#
Please enter a valid phone number.Format: (000) 000-0000.
Do you want me to coordinate Home Warranty?
Is buyer getting a loan?
Lender

Company NameLoan Officer/Processor
Loan Officer phone#
Please enter a valid phone number.Format: (000) 000-0000.
Loan Processor phone#
Please enter a valid phone number.Format: (000) 000-0000.
Escrow & Title

Title Company Escrow officer
Escrow officer Phone#
Please enter a valid phone number.Format: (000) 000-0000.
Escrow officer email
example@example.com
Escrow Team Phone#
Please enter a valid phone number.Format: (000) 000-0000.
Escrow Team Email
example@example.com
Name

First NameLast Name
Home Inspection
Preferred Inspection Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Inspection Company

Company NameContact Name
Inspection Company Phone#
Please enter a valid phone number.Format: (000) 000-0000.
Inspection Company Email
example@example.com
Listing Agent Commission (percentage or dollar - based on what amount?)
Buyers agent Commission (percentage or dollar - based on what amount?)
Any additional information i need to know?
Upload Agreement, counters, addendums etc

Cancelof
Should be Empty: