Dual Agent & Seller and Buyer Information Form View and download the Dual Agent Info Sheet from the link below.Download Dual Agent & Seller and Buyer Information FormEmail *A copy of this form will be sent to this address.FWLT File Number Agent InformationDual Agent Name Dual Agent Firm Dual Agent Phone Number Dual Agent Email Address Subject Property AddressStreet Address Street Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColorodoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Property InformationIs property subject to HOA dues? YesNoIs there a manufactured home included with the property? YesNoSeller InformationSeller Name Marital Status/Entity Type SingleMarriedSeparatedDivorcedWidowedCompanyEstateTrustCompany/Estate Representative Name Seller SSN (Last 4 Digits) Seller Spouse SSN (Last 4 Digits) Seller Email Address Seller Phone Number Will seller be attending closing? YesNoWill seller be using a POA at closing? YesNoSeller Payoff Information1st Mortgage Payoff Lender Name 1st Mortgage Payoff Loan Number 2nd Mortgage Payoff Lender Name 2nd Mortgage Payoff Loan Number Buyer InformationBuyer Name Buyer SSN (Last 4 Digits) Buyer Spouse SSN (Last 4 Digits) Marital Status/Entity Type SingleMarriedSeparatedDivorcedWidowedCompanyEstateTrustCompany/Estate Representative Name Buyer Email Address Buyer Phone Number Will buyer be attending closing? YesNoWill buyer be using a POA at closing? YesNoHUD-1 InformationFinal Contract Sales Price Earnest Money Deposit Amount Earnest Money Deposit Held By Dual AgentBuilderFWLTSeller Paid Closing Costs Dual Agent Commission Amount Dual Agent Admin Fee Invoices to be Paid at ClosingInvoice Type No Invoices to be collected on HUD-1Termite Inspection/TreatmentHome WarrantyRepairsOtherPaid By BuyerSellerDual AgentOtherInvoice Amount Invoice Paid To Invoice Type No Invoices to by Collected on HUD-1Termite Inspection/TreatmentHome WarrantyRepairsOtherPaid By BuyerSellerDual AgentOtherInvoice Amount Invoice Paid To Invoice Type No Invoices to by Collected on HUD-1Termite Inspection/TreamentHome WarrantyRepairsOtherPaid By BuyerSellerDual AgentOtherInvoice Amount Invoice Paid To Invoice Type No Invoices to be Collected on HUD-1Termite Inspection/TreamentHome WarrantyRepairsOtherPaid By BuyerSellerDual AgentOtherInvoice Amount Invoice Paid To Documents Needed for ClosingUpload Document Other Notes VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
