Buying Agent FormPlease note - All fields are required. If not applicable, please put N/A.Property InformationProperty Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Final Purchase Price(Required)Buyer InformationInformation will be used as written below for title commitment preparation. Please enter information exactly as it should appear on closing documents.Buyer Full Name(Required) First Last Buyer Marital Status(Required) Single Married Divorced Widow/WidowerSpouse Full Name First Last Buyer Primary Contact Email(Required)Buyer Primary Contact Phone Number(Required)Commission Amount & SplitInformation entered in this section will be used to calculate agent commissions.Buyer Agent Full Name(Required)Buyer Agent Email(Required)Buyer Agent Phone(Required)Commission based on(Required) Final Purchase Price OtherOther, please specify(Required)Percentage payable to the selling agent(Required)Percentage payable to the listing agent(Required)The Land Group confirms commission splits by asking both Selling & Listing Agents to communicate agent split prior to closing.Selling Agent Company (checks made “Payable to”)(Required)Agent License Number(Required)Broker License(Required)FeesIf fee is due outside of commission by your brokerage, please specify amount below.The Land Group requires copies of invoices to collect on Closing Disclosure. Please upload all copies via File Upload below.Transaction Fees*If a fee is collected outside of commission by your brokerage, please specify amount here. Yes NoTransaction Fee Amount(Required)Inspection Fees*Complete this section if any inspection fees will need to be settled on final closing disclosure. Yes - Buyer Pays Yes - Seller Pays NoInspection Fee Amount(Required)Home Warranty Fees*Complete this section if any home warranty fees will need to be settled on final closing disclosure. Yes - Buyer Pays Yes - Seller Pays NoHome Warranty Fees(Required)Are there any additional fees that need to be on the settlement statement?(Required)File Drop files here or Select filesAccepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 100 MB, Max. files: 10.Earnest Money Deposit HandlingAnswer these questions to share how you wish to handle the earnest money deposit.Earnest Money Deposit*Complete this section if any home warranty fees will need to be settled on final closing disclosure. Will be at closing - via check Deduct from agent commission OtherDescribe preferred Earnest Money Deposit handling below:(Required)Will Power of Attorney (POA) document preparation be needed?*If your Seller/Seller Spouse cannot attend the closing in-person for any reason, The Land Group will be able to prepare Power of Attorney prior to closing for an additional $150 fee. Yes NoWill a mail-away be needed?*Mail-away services are available if your Seller/s cannot make the in-person closing. The Land Group will facilitate document signature for an additional fee based on parcel service costs. Yes NoAdditional Comments/Considerations for The Land GroupNameThis field is for validation purposes and should be left unchanged.