C-3 Disbursement Sales
EXIT Strategy Realty
Your Full Name
*
First Name
Last Name
Your E-mail
*
Clients E-mail
*
example@example.com
Co-op Agents E-mail
*
example@example.com
Your Phone Number
*
-
Area Code
Phone Number
MLS Listing #
*
This Question is Mandatory
Property Address of Sale
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contract Date
*
-
Month
-
Day
Year
Date Picker Icon
Closing Date
*
-
Month
-
Day
Year
Date Picker Icon
Type
*
Please Select
Sale
Closing Price
*
We Represent
*
Please Select
Seller
Buyer
Both
Location of Funds
*
Please Select
Check attached
Mailed
Hand delivered to accounting department
Commission is renaming balance of earnest money
Earnest money + commission check
Seller's Side Office
*
Agent
*
First Name
Last Name
Agent
First Name
Last Name
Buyer's Side Office
*
Agent
*
First Name
Last Name
Agent
First Name
Last Name
Notes:
Amount of Earnest Money (ONLY APPLIES IF EXIT IS HOLDING EARNEST MONEY )
Commission Check (Received from title company)
*
Total Commission (Earnest money if applicable + Commsison check)
*
Commission Check
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Cancel
of
Contract/DISC
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of
Master Statement
Upload a File
Cancel
of
Listing Agreement
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Cancel
of
Will EXIT be paying additional brokers?
*
Please Select
No - Just Me
Yes - Multiple EXIT Strategy Brokers
Yes - Referral/Co-op Broker
If yes, you must complete the following information field!
Please provide all info regarding payment to additional brokers here:
Any Additional Notes for Processor
Submit
Should be Empty: