BUYER AGENT FORM

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Buyer(s) *

Preferred Phone Number *

Email *

Seller(s) *

Buyer's Property Purchase Type *

Buyer's Property Address *

Address Line 1

City

State

Zip Code

Settlement Date *

Buyer Marital Status *

Buyer Agent's Name *

Email *

Phone Number *

Agent License Number *

Office License Number *

Buyer Agent's Company Information *

Buyer Agent's Commission (%) *

Admin Fee *

Name