Contract Intake Form

Agent Name *

Brokerage Name *

Agent's Cell *

License # *

Agent Represents *

• Buyer
• Seller
• Both

Co-Agent

• Yes
• No

Cooperating Agent Name *

Cooperating Brokerage Name *

Cooperating Agent's Cell *

Email *

Property MLS # *

Property Sale Price *

EMD Amount *

Represented Client #1 Name *

Represented Client #1 Email *

Represented Client #1 Cell *

Represented Client #2 Name *

Represented Client #2 Email *

Name Effective Contact

Represented Client #2 Cell *

Contract Effective Date *

Date

Time

Contract Closing Date *

Date

Time

Home Warranty? *

• Yes
• No
• Other ...

Home Warranty Paid By... *

• Buyer
• Seller

Will TC Coordinate Home Warranty? *

• Yes
• No

Lender Contact Company Name *

Lender Name *

Lender Cell # *

Escrow Company *

Escrow Contact Person Name and Number *

Home Inspection *

• Scheduled
• Needs to be scheduled
• Would like TC to schedule
• Other...

Preferred Date for Inspection *

Date

Time

Inspection Company Contact Name *

Agent's Commission percentage or dollar amount *

Submit