Dual Agent & Seller and Buyer Information Form View and download the Dual Agent Info Sheet from the link below.Download If you are human, leave this field blank.Dual Agent & Seller and Buyer Information FormEmail *A copy of this form will be sent to this address.FWLT File NumberDual Agent NameDual Agent FirmDual Agent Phone NumberDual Agent Email AddressStreet AddressStreet Address Line 2CityStateAlabamaAlaskaArizonaArkansasCaliforniaColorodoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZipIs property subject to HOA dues?YesNoIs there a manufactured home included with the property?YesNoSeller NameMarital Status/Entity TypeSingleMarriedSeparatedDivorcedWidowedCompanyEstateTrustCompany/Estate Representative NameSeller SSN (Last 4 Digits)Seller Spouse SSN (Last 4 Digits)Seller Email AddressSeller Phone NumberWill seller be attending closing?YesNoWill seller be using a POA at closing?YesNo1st Mortgage Payoff Lender Name1st Mortgage Payoff Loan Number2nd Mortgage Payoff Lender Name2nd Mortgage Payoff Loan NumberBuyer NameBuyer SSN (Last 4 Digits)Buyer Spouse SSN (Last 4 Digits)Marital Status/Entity TypeSingleMarriedSeparatedDivorcedWidowedCompanyEstateTrustCompany/Estate Representative NameBuyer Email AddressBuyer Phone NumberWill buyer be attending closing?YesNoWill buyer be using a POA at closing?YesNoFinal Contract Sales PriceEarnest Money Deposit AmountEarnest Money Deposit Held ByDual AgentBuilderFWLTSeller Paid Closing CostsDual Agent Commission AmountDual Agent Admin FeeInvoice TypeNo Invoices to be collected on HUD-1Termite Inspection/TreatmentHome WarrantyRepairsOtherPaid ByBuyerSellerDual AgentOtherInvoice AmountInvoice Paid ToInvoice TypeNo Invoices to by Collected on HUD-1Termite Inspection/TreatmentHome WarrantyRepairsOtherPaid ByBuyerSellerDual AgentOtherInvoice AmountInvoice Paid ToInvoice TypeNo Invoices to by Collected on HUD-1Termite Inspection/TreamentHome WarrantyRepairsOtherPaid ByBuyerSellerDual AgentOtherInvoice AmountInvoice Paid ToInvoice TypeNo Invoices to be Collected on HUD-1Termite Inspection/TreamentHome WarrantyRepairsOtherPaid ByBuyerSellerDual AgentOtherInvoice AmountInvoice Paid ToUpload DocumentOther NotesSubmit
