Household Title
Home
About
FAQs
Our Services
Order
For Buyers
Good Faith Estimate
Title Insurance
Surveys
Closing Smoothly
Buyer Guidelines
Closing Process
Timeline
Utilities and Services
Privacy Policy
For Sellers
Closing Process
Closing Information Sheet
Privacy Policy
For Realtors
Seller Agent Questionnaire
Listing Agent Questionnaire
Calculators
Good Faith Estimates
Other Calculators
Debt Consolidation
How Much Home Can I Afford?
Mortgage Calculator
Renting vs. Buying
Contact
You are here:
Home
»
For Realtors
»
Listing Agent Questionnaire
Listing Agent Questionnaire
Listing Agent Questionnaire
This form is to be completed by the listing agent or brokerage firm representing the seller. Please complete or update as much of this information as possible. This questionnaire has traditionally been mailed or faxed in, but is now available for online completion for your convenience!
Settlement Date
Household Title File Number
Buyer's Name
First
Last
Seller's Name
First
Last
Subject Property Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Listing Agent's Name
First
Last
Listing Brokerage Name
Listing Brokerage Company Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
Fax
E-mail
Commission and Administrative Fee Information
Listing Agent Gross Commission Earned
Please fill in the percentage here.
Please fill in the dollar amount here.
Deposit Held by Brokerage Firm (if any): $
Dollar Amount Contributed from Listing Agent’s Commission (if any): $
Net Amount of Commission Check Expected at Settlement: $
*
Listing Agent Administrative Fee: $
Payee Name
Other Information
Seller's Name
First
Last
Seller's Home Phone
Seller's Work Phone
Seller's Cell Phone
Seller's E-mail
Amount of Seller Credit (if any): $
Is there a sale/lease-back period?
Yes
No
Deposit to Withhold: $
What is the end date of the lease-back period?
Fee for Rent-Back Period: $
Are transfer taxes being split 50/50?
Yes
No
If not, how are they being split?
Is the seller paying for a home warranty?
Yes
No
Fee to Collect From Seller: $
Company Name
HOA/Condo Fee Information
HOA/Condo Name (if any):
Phone
Fax
HOA/Condo Fees: $
Per:
Month
Quarter
6 Months
Year
Is water included in the condo fee?
Yes
No
Seller's Residency Status
Is the seller a resident of the state where the property is located?
Yes
No
Is the property the seller's principal residence?
Yes
No
Is the seller subject to withholding for federal or state income taxes due to the sale of the subject property?
Yes
No
Not Sure
