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.
Email
example@example.com
Agent Represents
Cooperating agent

Name Brokerage
Cell#
Please enter a valid phone number.
Email
example@example.com
Client name

First NameLast Name
Client Email
example@example.com
Client cell phone
Please enter a valid phone number.
Client name

First NameLast Name
Client Email
example@example.com
Client cell phone
Please enter a valid phone number.
MLS#
Property Address

Street Address

Condo or Space number

CityState

Zip Code
Sales Price
EMD Amount
Contract Effective Date

MonthDayYear
Date
Closing Date

MonthDayYear
Date
Home Warranty
Warranty CompanyContact person
Warranty Company#
Please enter a valid phone number.
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.
Loan Processor phone#
Please enter a valid phone number.
Escrow & Title

Title Company Escrow officer
Escrow officer Phone#
Please enter a valid phone number.
Escrow officer email
example@example.com
Escrow Team Phone#
Please enter a valid phone number.
Escrow Team Email
example@example.com
Name

First NameLast Name
Home Inspection
Preferred Inspection Date

MonthDayYear
Date
Inspection Company

Company NameContact Name
Inspection Company Phone#
Please enter a valid phone number.
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
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