BUYER AGENT FORM Your transaction has never been easier. Fill out the form and we’ll contact you soon with additional information and next steps. RECOMMENDED BROWSERS: Google Chrome, Microsoft Edge, or Safari Please enable JavaScript in your browser to complete this form.12Buyer(s) *Preferred Phone Number *Email *Seller(s) *Buyer's Property Purchase Type *PrimaryInvestmentBuyer's Property Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBuyer's Forwarding/Primary Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSettlement Date *Buyer Marital Status *Married CoupleMarriedSingleDivorcedWidowedBuyer Agent's Name *Email *Phone Number *Agent License Number *Office License Number *Buyer Agent's Company Information *Buyer Agent's Commission (%) *Admin Fee *NextBuyer's Lender *Loan Officer *Email *Phone Number *Termite inspection to be done by: *SellerBuyerTermite Inspection Company Information *Is the Buyer planning a Power Of Attorney? *YesNoFrom: *To: *Does this transaction require a Home Warranty? *YesNoWarranty Provider *Cost *Paid by: *Rent Back *YesNoIF YES, PLEASE PROVIDE A COPY OF THE RENT BACK AGREEMENT.Will the Buyer be bringing an Assignment of Funds from the sale of home as part of the down payment? *YesNoAre there any broker credits offered to the Buyer or Seller? *YesNoAmount of credits: *To: *Attach the Broker Credit Letter Click or drag files to this area to upload. You can upload up to 2 files. If you do not have this letter available, you may email the form later to escrow@loudountitle.comAre there any credits, charges, or payments (per the contract) that we need to be aware of? If so, please explain below. Provide any additional information here as well. PreviousWebsiteSubmit