EmailMeForm
Agent Intake Form
Dear Agent,
In order for American Real Title to better serve you and your client(s), the following additional information is required to prepare for your closing on the property.
PLEASE NOTE THAT OUTGOING WIRES INCUR A FEE OF $15.00 EACH WHICH IS CHARGED BY SANIBEL CAPTIVA COMMUNITY BANK. THIS WILL BE DEDUCTED FROM YOUR COMMISSION IF YOU CHOOSE TO RECEIVE THE SAME VIA WIRE.
By checking this box you hereby consent to submitting the following information electronically, that you are an authorized agent to do so, and that all information provided is truthful and accurate.
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Yes
If for any reason you are not able to check this box please contact our office at 239-768-0144 for further instructions.
Sellers Name:
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First
Last
Buyers Name:
*
First
Last
Closing Property Address:
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Please fill in entire address including any Suite or Apt#s
Agent's Information
Which party are you representing?
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Buyer
Seller
Agent's Name
*
First
Last
Company Name:
*
Mailing Address:
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Phone
*
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Fax
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-
###
-
####
Email
*
Are there transcation fees not listed on Contract?
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Yes
No
If yes, please fill in next question. If no move onto Commission Percentage.
If yes, please list all additional transaction fees below.
Commission percentage being paid?
*
Enter percentage in box, number only. i.e. 3% enter 3. If 0% enter 0.
NOTE:
Will commissions be paid directly to Agent? If so, please provide a disbursement authorization executed by Broker.
File Upload (If you have a digital copy of the Disbursement Authorization executed by the Broker you can upload it here, file types accepted: PDF, .doc, .txt, .zip)
Any additional comments or information we need to know?
Leave blank if no.
