Listing Agent Information Form

The purchaser(s) have selected our company FIRST TITLE OF BROWARD, INC to conduct the settlement in connection with the sale of your property. As settlement agents, we are responsible for paying off and releasing all existing liens against the property, notifying any homeowners association and paying any outstanding dues, conducting the settlement, and forwarding proof of this transaction to the Internal Service Revenue

Please Provide The Information Below To Assist Us In Processing This Transaction.

Are we allowed to contact your Client? YesNo

Seler Name

First Name: *

Last Name: *

Social Security: *

EIN Numbers: Seller: *

Marital Status MarriedSingleDivorcedWidowed

US CITIZEN: YesNo

Please leave this field empty.

Seller Email: *

Cell No: *

Phone No. Work: *

Phone No. Home: *

Mailing address for Futures use: Property Address: *

Second Seller Name (if applicable)

First Name:

Last Name:

Social Security:

EIN Numbers: Purchaser:

Marital Status MarriedSingleDivorcedWidowed

US CITIZEN: YesNo

Purchaser Email:

Cell No:

Phone No. Work:

Phone No. Home:

Forwarding address:

Notes:

If Sellers are divorced must provide with Marital Settlement Agreement and Divorce Decree.
If Seller is a Trust, must provide copy of Trust
If Widow, will need to provide Death Certificate of Spouse.

1st Existing Lender Contact - Account Number:

Name:

Phone No:

Email:

2nd Existing Lender Contact - Account Number:

Name:

Phone No:

Email:

Homeowner Assoc. Mgmt. Co YesNo

Phone No:

Email:

Is there a 2nd HOA? YesNo

Commission Breakdown: Listing %:

Administrative/Processing Fees: $

Listing Agent Name:

License #:

Broker Company Name:

Broker ID #:

Phone #:

E/M:

REIMBURSE LISTING AGENT: YesNo

Commission Breakdown: Listing %:

Administrative/Processing Fees: $

Selling Agent Name:

License #:

Broker Company Name:

Broker ID #:

Phone #:

E/M:

Homeowner Warranty: YesNo

HOA Docs $

Invoices: $

Broker Company Name:

Broker ID #:

Listing Agent Name:

License #:

Phone #:

E/M:

Notes - in case any additional information is required (i.e., 3rd purchaser, buying in a trust, etc.) *

Below is contact information’s should you have any questions please feel free to contact FIRST TITLE OF BROWARD.

Transaction Number:

Pre-Processor:

Phone #:

E/M:

Senior Processor:

Phone #:

E/M:

Attorney:

Phone #:

E/M:

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Listing Agent Information Form