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 Δ
