REALTOR
Please submit the form below or download the form and fax it to 910.799.3250.
REAL ESTATE AGENT INFORMATION
Agent Name
Real Estate Firm
Agent Phone
Agent Fax
SELLER(S) INFORMATION
Seller(s) Name
Property Address
City
 State Zip
Seller Phone
   
Seller's Agent Name
    
Agent Phone
    
BUYER(S) INFORMATION (Must be completed to perform work.)
Buyer(s) Name
Buyer(s) Address
City
 State Zip
Buyer Phone
   
Buyer's Agent Name
    
Agent Phone
    
CLOSING INFORMATION
Attorney Name
Attorney Address
City
 State Zip
Attorney Phone
   
Attorney Fax
   
Closing Date
   
Type of Loan
 Conventional FHA VA Cash Other
SERVICE INFORMATION
Service Address
City
 State Zip
Lock Box
Yes No    
Occupied
 Yes No    
Termite Estimate Needed
 Yes No