C-3 Disbursement Rentals
EXIT Strategy Realty
Your Full Name
*
First Name
Last Name
Your E-mail
*
Your Phone Number
*
-
Area Code
Phone Number
MLS #
*
This Question is Mandatory
Property Address of Rental
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Lease Date
*
-
Month
-
Day
Year
Date Picker Icon
Type
*
Please Select
Rental
Monthly Rent
*
We Represent
*
Please Select
Landlord
Tenant
Both
Location of Funds
*
Please Select
Check attached
Mailed
Hand delivered to accounting department
Seller's Side Office
*
Agent
*
First Name
Last Name
Buyer's Side Office
*
Agent
*
First Name
Last Name
Agent
First Name
Last Name
Notes:
Amount of Commission Check
*
Lease or Invoice
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of
Commission Check
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of
Additional Documents
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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:
ex: Name of Agent / Broker Address
Any Additional Notes for Processor
Submit
Should be Empty: