Capitis Agent

Transaction Type Open EscrowListingShort Sale

Purchase Price

Close of Escrow

Agent Name (required) Cell Phone Capitis Agent Email (required)

You will receive a copy of this form to your agent email as soon as it’s submitted.

Referral

Referral? NoYesListing SideSelling SideN/A

Percentage %

Name

Brokerage

Referral paperwork signed and delivered to TM or Broker? NoYesN/AAttached Yes

If Referral, Get W-9 signed and give to Wendy.

Subject Property

Representing BuyerSellerBoth

Subject Property Address

City, State Zip

Access (supra, combo, gate code)

Vacant? NoYesREO? NoYesShort Sale? NoYes

Solar Panels YesNo LeasedOwnedN/A

Commission:Listing % Selling %

MLS Attached NoYes

HOA Information

HOA? NoYes

Home Owners Association

Phone

Email

Dues $

Brokerage

Cooperating Agent Brokerage

Agent’s Name

Email

Office Phone

Cell Phone

Escrow

Escrow Company

Escrow Agent

Email

Phone

Cell Phone

EMD in Trust? NoYes

Seller Information

Seller Name(s)

Address

Email

Home Phone

Cell Phone

Seller English Speaking? NoYesIs Seller a Trust? NoYes

Buyer Information

Buyer’s Name(s)

Address

Email

Home Phone

Cell Phone

Buyer English Speaking? NoYesIs Buyer a Trust? NoYes

Buyers Financing

Cash NoYesLoan Type? ConventionalFHAVAN/AOwner Occupied NoYes

Lenders Company

Lender Contact Name

Lender Email

Lender Phone

Cell Phone


Additional Information