AMY 7967 Cincinnati-Dayton Rd, Ste A West Chester, OH 45069 PH: (937) 265-8501 FAX: (937) 866-8219 Email: amy@prioritynationaltitle.com THE LENDER DOES NOT GIVE US UPDATES OR STATUS OF THE LOAN. You are welcome to schedule closing, we just will not know of status. Your email address * Form Submitted by * Listing AgentSelling AgentDual Agent Property Address * Final Sales Price * Your Commission Amount* Listing Agent Commission * Listing Broker/Processing Fees * Selling Agent Commission * Selling Broker/Processing Fees * Dual Agent Commission * Dual Broker/Processing Fees * Total Earnest $ Deposit Amt * Earnest $ held by: * Earnest money to be withheld from Agent Commission? * YESNO Home Warranty? * YESNO Warranty paid by: * BUYERSELLER Amount of Warranty * Home Warranty Company * Seller Paid Costs to Borrower * Obtaining the seller(s) payoffs? * YESNO If part of Homeowner's Association, provide contact info * Listing Agent License ID # Listing Agent Name Listing Company & Co. License ID # Listing Phone Listing Fax Listing Email Dual Agent License ID # * Dual Agent Name * Dual Company & Co. License ID # * Dual Phone * Dual Fax * Dual Email * Buyer Marital Status * MarriedSingleDivorcedWidowOther Buyer Name * Buyer Contact Number * Buyer Email * Buyer Spouse Name Additional Buyer Name * Additional Buyer Contact Number * Additional Buyer Email Will buyer(s) and (if applicable) spouse(s) attend closing? YESNO Selling Agent License ID # * Selling Agent Name * Selling Company & Co. License ID # * Selling Phone * Selling Fax * Selling Email * Seller Marital Status * MarriedSingleDivorcedWidowOther Seller Name * Is Seller a citizen of the United States? * YESNO This is a FIRPTA - please have your seller contact us immediately. Seller Contact Number * Seller Email * Seller Spouse Name * Additional Seller Contact Number * Additional Seller Email Will seller(s) and (if applicable) spouse(s) attend closing? * YESNO Seller Marital Status * MarriedSingleDivorcedWidowOther Seller Name * Seller Contact Number * Seller Email * Seller Spouse Name * Will seller(s) and (if applicable) spouse(s) attend closing? * YESNO Buyer Marital Status * MarriedSingleDivorcedWidowOther Buyer Name * Buyer Contact Number * Buyer Email * Buyer Spouse Name Will buyer(s) and (if applicable) spouse(s) attend closing? YESNO Are there any Rents, Deposits or Prorations? Additional Information
