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Fidelity Land Title Agency

Selling Agent Info Form

Agent's Name *

Agency/ Brokerage *

Phone *

Fax Number

Email *

Property Address *

Property City *

Property State *

Property Zip *

Purchase Price *

Broker Fees *

Selling Commission *

Buyer's Marital Status *

• Ohio dower law requires the spouse’s signatures on mortgages even if they are not in title or on the loan. Dower does not cease until final a final decree of divorce is filed with the court.

Buyer's Name *

Spouse's Name *

Buyer's E-mail *

Buyer's Phone *

Does the buyer want to purchase and Owner's Title Insurance Policy? *

Earnest Money Deposit Amount *

Earnest Money to be held by? *

Earnest Money to be deducted from commission? *

Is a Home Warranty being purchased? *

Home Warranty Amount *

Home Warranty Paid for by *

Home Warranty Company *

Any additional info your would like us to know about your transaction

*************** WIRE INSTRUCTION DELIVERY INFORMATION ***************

Due to an increase in cyber/wire fraud crime we are letting you know now that
THE MOST SECURE way to obtain our wire instructions is for you or your buyer(s) to log in to our MY CLOSING feature on our website at . After submitting this form, your buyer(s) will be receiving an invitation to create a login/password to be able to obtain closing docs. and wire instructions directly from our website. Any other transmission of wire instructions that you or your buyer receive should be viewed with extreme caution as they may be fraudulent. Please contact us immediately if you are your client receive wire insturctions by an other manner than through our website's My Closing feature. Our wire instruction will not change. We ask that you please relay this information on to your buyers.

I have read the above disclosure about wire instruction delivery:

Document Upload (Addendum's,Trust/LLC docs, Corp Resolutions, Surveys, ect....)
(Max 12MB, File Types: .gif, .png, .jpg, .pdf, .xls, .doc, .docx)

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