Selling Broker Settlement Information Request Please fill in all required and applicable fields on this secured form.File No.Property AddressNameContact Information:Brokerage Company NameBrokerage Company AddressBrokerage Company State License IDAgent's NameAgent's State License IDAgent's E-MailAgent's Phone NumberCommission Information:Total Commission AmountSelling Agent % / $General Information:Do you have an administrative/flat fee?YesNoIf yes, please list the amount hereWill there be any reimbursements due to you at closing?YesNoIf "Yes", please specify said reimbursement(s) hereAre there any credits to Purchaser or Seller from you at closing?YesNoIf "Yes", please specify said credit(s) here and upload broker letter belowLender Information:Please provide us with the Purchaser's lender name and contact information (if applicable):Company NameLoan OfficerLoan Officer's Contact Phone NumberLoan Officer's E-mail AddressIf the purchaser is paying for the following, please provide the information requested below:Termite Company Name & Phone NumberWell Report Company Name & Phone NumberSeptic Report Company Name & Phone NumberHome WarrantyYesNoIf the purchaser is obtaining a home warranty at closing, please PROVIDE A COPY OF THE INVOICE prior to closing. You may attach it below.If you are providing a commission credit, PLEASE PROVIDE A BROKER LETTER. You may attach it below.Select files to attachSize limit for each file is 100 MBThis feature requires JavascriptGeneral CommentsSubmit