Buyer/Agent Form Buyer’s Agent Form 620 GREEN VALLEY ROAD, SUITE 200 GREENSBORO, NORTH CAROLINA 27408 WWW.CHANDLERANDSCHIFFMAN.COM MICHAEL R. CHANDLER, ESQ. ADELIA T. SCHIFFMAN, ESQ. CAMERON E. JOHANNESEN, ESQ. CHRISTIAN M. HAIRSTON, ESQ. TELEPHONE: (336) 274-4455 FACSIMILE: (336) 274-7030 Buyer Names: * Seller Names: * Property Address: * Closing Date: BUYER’S AGENT SHEET ALL Buyer Names: Buyers Email Address: Phone Number: Buyers Marital Status: UNMARRIED MARRIED SEPARATED WIDOWED Agent’s Email Address: Phone Number: COMMISSION SPLIT: Selling Realtor Listing Realtor Flat Fee Amount Earnest Money: None OtherOther Held By: Listing Agent Selling Agent Attorney INVOICES TO BE PAID AT CLOSING: Company Cost Paid By: Buyer Seller Upload File Upload Drop a file here or click to upload Choose File Maximum upload size: 5MB Company Cost Paid By: Buyer Seller Upload File Upload Drop a file here or click to upload Choose File Maximum upload size: 5MB Company Cost Paid By: Buyer Seller Upload File Upload Drop a file here or click to upload Choose File Maximum upload size: 5MB Company Cost Paid By: Buyer Seller Upload File Upload Drop a file here or click to upload Choose File Maximum upload size: 5MB Company Cost Paid By: Buyer Seller Upload File Upload Drop a file here or click to upload Choose File Maximum upload size: 5MB Company Cost Paid By: Buyer Seller Upload File Upload Drop a file here or click to upload Choose File Maximum upload size: 5MB Company Cost Paid By: Buyer Seller Upload File Upload Drop a file here or click to upload Choose File Maximum upload size: 5MB Company Cost Paid By: Buyer Seller Upload File Upload Drop a file here or click to upload Choose File Maximum upload size: 5MB ••Please send all invoices to be paid at closing.•• reCAPTCHA If you are human, leave this field blank. Submit Δ Contact Us Name Email Address Message 2 + 15 = Submit Request
