New Customer Registration Form

New Customer Registration Form
Customer Details:
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Professional Information*

License #

Buyers Agent or Listing Agent

Firm NameFirm License #

MLS#
Purchase Price
Do you have more than one client on this transaction?
Clients 1 Name*
Clients 1 Email*
Client 1 Phone Number*
Client 2 Name (Spouse or Partner)
Clients 2 Email (Spouse or Partner)
Clients 2 Phone Number (Spouse or Partner)
Closing/ Escrow Office Information. (Name, phone, email, contact name.*
Lender Information (Name, phone, email, contact name).*
Effective Date of Contract*

MonthDayYear
Date
Due Diligence Date*

MonthDayYear
Date
Closing Date*

MonthDayYear
Date
Earnest Money Amount*
Due Diligence Amount*
Is there anything else we need to know about you or your clients needs?
Please upload all document files here.
File Upload*

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By signing below you are agreeing to the terms and conditions of Your Raleigh Realtor Services. You agree by submitting your information and payment for services rendered that these fees are non refundable. You agree that you are entrusting Raleigh Realtor Services with sensitive information and that all RESPA and privacy laws will be upheld in this transaction. You also agree that Raleigh Realtor Services is not liable legally or otherwise for any discrepancy, misinterpretations or misrepresentation of information you have have submitted.

Raleigh Realtor Services assumes no reponsibility or liability for the legality or legal outcomes of your transaction.
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