Transaction Intake Form
Agent Name:
Coop agent name:
Brokerage:
License#:
Mobile #:
Email:
Agent represents:
Buyer
Seller
Both
Cooperating Agent
Brokerage
Mobile #:
Email
example@example.com
MLS #
Property Address
Sale Price
Earnest Money Amount
Represented Client 1 Name
Client Email
example@example.com
Client Mobile
Represented Client 2 Name
Client Email
example@example.com
Client Mobile #
Contract Effective Date
/
Month
/
Day
Year
Date
Closing Date
/
Month
/
Day
Year
Date
Home Warranty
Yes
No
Warranty Company
Please Select
Blue Ribbon Home Warranty
2-10 Home Warranty
First American Home Warranty
AFC Home Warranty
Liberty Home Guard
American Home Shield
Cinch Home Services
Home Warranty of America
Other
Warranty Paid by
Seller
Buyer
Agent
Transaction Coordinator to Coordinate Warranty
Yes
No
Financing
Yes
Cash
Lender Contact
Company
Name
Email
Mobile #
Title Company
Company
Name
Contact #
Home Inspection
Scheduled
Needs to be scheduled
Preferred Date
/
Month
/
Day
Year
Date
Inspection Company Contact
Company
Name
Mobile #
Agent Commission
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