Seller Agent Questionnaire

This form is to be completed by the seller 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
FirstLast
Subject Property Address*
Street AddressAddress Line 2CityStateZip Code
Sale Price: $
Property Tax ID Number
County
Buyer's Agent's Name
FirstLast
Buyer's Brokerage Company Name
Buyer's Brokerage Company Address
Street AddressAddress Line 2CityStateZip Code
Phone
Fax
E-mail
Buyer's Mailing Address
Street AddressAddress Line 2CityStateZip Code
Buyer's Home Phone
Buyer's Work Phone
Buyer's Cell Phone
Buyer's E-Mail
Deposit: $
Who is holding the deposit?
FirstLast
Commission and Administrative Fee Information
Selling Agent Gross Commission Earned
Please specify whether you are providing the percentage or the dollar amount.
Deposit Held by Brokerage Firm (if any): $
Net Commission Check Expected at Settlement: $*
Selling Agent Administrative Fee: $
Made Payable to Whom
FirstLast
Buyer Information
Is the buyer a first-time homebuyer?
- Yes
- No
Will the buyer occupy this as their principal residence?
- Yes
- No
Is there a sale/lease-back period?
- Yes
- No
Fee for Rent-Back Period: $
Are transfer taxes being split 50/50?
- Yes
- No
If not, how are taxes split?
Amount to collect from buyer for pest inspection: $
Payee Name

Seller Agent Questionnaire

Seller Agent Questionnaire

Commission and Administrative Fee Information

Buyer Information

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