Listing Agent FormAll fields are required. If not applicable, put N/A. Thank you for for your prompt completion of this form.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)Seller InformationInformation will aid title search, title commitment preparation, and files for reference through lien and mortgage payoffs as needed.Seller Full Name(Required) First Last Seller Marital Status(Required) Single Married Divorced Widow/WidowerSpouse Full Name First Last Seller Contact Email(Required) Seller Phone(Required)Seller Forwarding Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Commission Amount & Agent SplitInformation entered in this section will be used to calculate agent commissions.Listing Agent Full Name(Required) First Last Listing Agent Email(Required) Agent Commission based on(Required) Final Purchase Price OtherOther, please specify(Required)Percentage To Listing Agent(Required)Percentage To Selling Agent(Required)The Land Group confirms commission splits by asking both Selling & Listing Agents to communicate agent split prior to closing.Listing Agent Company (checks made “Payable to”)(Required)Agent License(Required)Broker License(Required)FeesThe Land Group requires copies of invoices before closing in order to collect on Closing Disclosure. Please answer each fee question below.Transaction/Admin Fees*If fee is due outside of commission by your brokerage, please specify the amount here. Yes NoFee AmountInspection Fees*If inspection costs are being handled within closing, please specify here. Yes NoInspection CostsHome Warranty Fees*If home warranty costs are being handled at closing, please specify here. Yes NoHome Warranty FeesIs the property in a Home Owners Association?(Required) Yes NoName of HOA (Home Owner Association)(Required)HOA Point of Contact(Required)HOA Contact - EmailHOA Contact - PhoneFileUpload applicable invoices/receipts for fees/costs noted above here. Drop files here or Select filesAccepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 100 MB, Max. files: 10.Closing DetailsWill a POA 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 NoWill the sellers need us to order a primary or secondary mortgage payoff?(Required) Yes NoSelect your preferred method for payoff handling by The Land Group:(Required) I will forward Seller Authorization directions to my client for completion and recognize wet signatures are required. I would like The Land Group to reach out to my client to manage payoff directly.Seller Authorization FormAdditional Comments/Considerations for The Land GroupNameThis field is for validation purposes and should be left unchanged.