SELLER 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.12Seller(s) *Preferred Phone Number *Email *Buyer(s) *Property Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeListing Agent's Name *Email *Phone Number *Agent License Number *Office License Number *Listing Agent's Company Information *Listing Agent Commission (%) *Selling Agent Commission (%) *Admin Fee paid by Seller *NextTermite Inspection Company *Phone Number *Home Warranty *YesNoWarranty Provider *Cost *Paid by: *Is the Seller planning a Power Of Attorney? *YesNoIs there any pre-occupancy or post-occupancy (Rent Back)? *YesNoIF YES, PLEASE PROVIDE A COPY OF THE RENT BACK AGREEMENT.Are 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. PreviousCommentSubmit