New Escrow / Seller Disclosures Request Name * First, Last First Name Last Name Number * Email * Message Who are you representing? Buyer Seller Dual Title Rep and Contact Leave Blank if Not Applicable Property Type SFR Commercial Duplex Triplex Other Transaction Type All if Applicable SFR Trust Probate Condo Land REO Short Sale Mobile New Home Other Finance Type Conventional FHA VA Cash Other Property Address (Complete) County MLS # SELM or NA Sales Price LOC% (Listing Office) Leave Blank if Not Applicable SCO% (Buyer's Side) Leave Blank if Not Applicable COE Close of Escrow Date Leave Blank if Not Applicable MM DD YYYY Acceptance Date Leave Blank if Not Applicable MM DD YYYY Inspection Contingency Date Leave Blank if Not Applicable MM DD YYYY Appraisal Contingency Date Leave Blank if Not Applicable MM DD YYYY Loan Contingency Date Leave Blank if Not Applicable MM DD YYYY Listing Agent Name and Contact Co-Listing Agent? Yes No Do you have a co-broker or referral? Yes No Seller 1 Name Leave Blank if Not Applicable Seller 1 Email and Phone Leave Blank if Not Applicable Seller 2 Name Leave Blank if Not Applicable Seller 2 Email and Phone Leave Blank if Not Applicable Company Name for Buyer's Broker Agent for Buyer - Name and Contact Buyer 1 Name Buyer 1 Email and Phone Buyer 2 Name Buyer 2 Email and Phone Escrow Company Name Leave Blank if Not Applicable Escrow Officer Name and Contact Leave Blank if Not Applicable Home Warranty Co. Leave Blank if Not Applicable Home Warranty Reps Name Leave Blank if Not Applicable Lender / Mortgage Broker Company Write NA or Cash if not applicable Lending Rep Name Write NA or Cash if not applicable TC Invoice of $354.95 is paid by: * (TC Fee Waived if Using Landmark Trust Escrow) Buyer Seller Agent on File Addt'l Notes and Instructions Upload Files FileField;MaxSize=10000;Multiple;addText=Add_your_Files; Thank you for submitting your new escrow, a member of our team will confirm receipt shortly!
