NEW CUSTOMER APPLICATION
(* =
required field) |
Are
you a repeat customer? |
Agent Name:*
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SS#:*
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Agent Birthdate:* (ie. 10/02/1952)
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Email Address:*
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Real Estate License #:*
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Home Phone:*
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Home Fax:
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Mobile Phone:*
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Home Address:*
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City:*
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State:*
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ZIP:*
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I am the:
Listing Agent
Listing Broker
Buyer's Agent
Buyer's Broker
My Home is :
Owned
Leased |
Company Name:*
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Broker/Auth. Rep.:*
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Years with Present Company:*
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Company Phone:*
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Company Fax:*
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Year Licensed:*
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Company Address:*
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City:*
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State:*
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ZIP:*
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Contact Person for Commission Accounting:*
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Contact Person's Phone Number:*
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Contact Person's Email Address:
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Company Website:
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Bank (Personal):*
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If name on account is different than
agent's, please list:
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Account #:*
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Routing #:*
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Property Address:*
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City:*
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State:*
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ZIP:*
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Seller:*
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Purchaser:*
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Is Buyer investor?
Yes
No |
Is this a Short Sale?
Yes
No |
Earnest
Money Amount:*
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Appraisal?:
Not Ordered
Ordered
Completed
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If completed, enter amount of appraisal:
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Settlement Agent (Title Co.):*
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Settlement Rep. (Closer):*
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File Number:
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Settlement Rep Phone:*
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Settlement Rep Fax:*
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Settlement Agent Address:*
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City:*
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State:*
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ZIP:*
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Lender:*
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Loan Officer:*
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If Cash deal, please type 'CASH' in Lender Box. |
Lender Phone :
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Lender Fax:
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Lender Email Address:
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Lender Address:
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City:
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State:
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ZIP:
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Amount Financed:*
100%
95%
90%
85% or less
Cash
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Type of Financing:
Conventional
FHA/Government
Owner Carried
Cash
Other |
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Contract Execution Date:
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Option Period Expiration Date:
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Closing Date:*
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Closing Time:
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Final Contract Price:*
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Describe any Non-Financing Contingencies in Detail:
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New Construction:
Yes
No
If 'Yes':
Builder Contact:
Builder Phone:
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Receivable Amount:
(Agent's share of commission)
After ALL expenses & deductions, NET amount due to you |
Do you want to sell your entire Receivable, or just a part of it:
All
Part
If Part, enter amount you would like to receive:
(Commission Express will do the calculations to ensure that you receive this exact amount)
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Contracts Currently Pending:
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Closings in Past 12
Months:
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Current Number of Listings:
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Last
Year's Total Income:
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How would you like to receive your advance?
Overnight delivery to my home (Overnight charge is $44, no charge if you supply a FedEx, UPS, DHL or LSO account # at
right)
Overnight delivery to my office (Overnight charge is $44, no charge if you supply a FedEx, UPS, DHL or LSO account # at
right)
Wire transfer to account on my application ($39)
I'll pick it up at the Commission Express office
I'll let you know later |
Overnight charge is $25 weekdays, $44 Saturday, no charge if you supply a FedEx, UPS, DHL or LSO account #:
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Please send my documents via:
Email
Fax to office
Fax to home
Call me first |
Check
here for same-day rush service (Optional)
Your application will be processed immediately (usually in under one
hour), and your advance will fund same-day if your papers are completed
by 12:00 noon. There is a $79
fee for this optional service, which includes your choice of wire
transfer or overnight delivery. Standard service typically funds the
following day. If this is your first advance with Commission
Express, please tell us how you heard about us (and we like to say
thanks for referrals, so if it's a person please tell us their name):
Here's where you can tell us anything special:
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Certification:
I certify under penalty of perjury and of obtaining money under false
pretenses that the information provided in this Application is true and
correct as of today's date and acknowledge my understanding that any
intentional or negligent misrepresentations of the information
contained in this application may result in civil liability and/or
criminal penalties and liability for monetary damages to Commission
Express, its agents, successors, and assigns, insurers and any other
person who may suffer any loss due to reliance upon any
misrepresentation which I have made on this application. I am at least
18 years of age and a United States citizen. I authorize Commission
Express to review my credit history and any other information in order
to approve or decline my application, service my account, and manage
its relationship with me. I authorize Commission Express to share with
others, to the extent permitted by law, such information and its credit
experience with me. I consent to and authorize Commission Express
to monitor and/or record any of my phone conversations with any of
their representatives.
I acknowledge the above certification |
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Remember me as a return customer on future visits! |
| Information submitted is never sold to any third parties. |
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