Commission Disbursement Request

To request a commission check for a transaction that is about to close, simply fill out and submit the form below:

Unless you are revising your original commission disbursement request, please submit your request at least two business days before your expected closing date!

ITEMS IN GREEN ARE REQUIRED!

Commission Disbursement Checklist (Required prior to disbursement)

Select a choice for all transaction types

 Did you fax Broker a copy of the entire final sales contract, including all addendums and critical documentation?  Yes No

If representing the Buyer, select an option other than 'N/A'

 Did you attach Broker's Commission Sharing Disclosure Addendum to the sales contract?  Yes No N/A

If representing the Seller, select an option other than 'N/A'

 Did you fax Broker a copy of the entire Listing Agreement, including all addendums?  Yes No N/A
Transaction Information
Your Name:
Your E-Mail Address:

Street Address or Legal Desc*:

City, St, Zip":
Who are you representing?: Not Selected Seller Buyer Both
Seller(s):
Buyer(s):
Est. Closing Date: (mm-dd-yyyy format)
Sales Price: (do not enter $ signs)
Commission Amount Requested Information
Commission Based On:
Examples:
"3% of sales price"
"3% of sales price, plus a $500 agent bonus"
"3% of $225,000 - the price agreed to base the commission on"
Gross Commission Amount Due Broker
 (before any splits):		 (do not enter $ signs)
Commission Amount Shared With Buyer
(if representing Buyer):		 (do not enter $ signs)
Net Commission Amount Due Broker
 (don't include agent/broker split):		 (do not enter $ signs)
Special Notes/Instructions To Broker
Notes and/or Instructions To Broker:
Title Company Information
Title Co.:
Title Company's Address:
Closer's Name:
Title Co. Phone: (999-999-9999 format)
Closer's Phone: (999-999-9999 format)
Closer's Fax: (999-999-9999 format)
Associate's Commission Disbursement Instructions for Title Company

What Form of Payment Do You Prefer?

 Check (default method for pick up or mailings)
Direct Deposit (Bank and/or Title Co. Charges May Apply)
Bank Name:
Bank City, St:
Name on Account:
Routing No:
Account No: