FrickTrentLizzio, PLLC
141 Providence Road STE 110
Charlotte, NC 28207
Phone: 704-376-8181

Buyer's Agent Info Form

If you would like to submit the information below via fax instead, then please download our buyer's agent info offline form.

Be assured that all information submitted here is safe and secured.

FrickTrentLizzio, PLLC will handle the closing. *
Your Email Address *

Purchaser's Information

Purchaser's Name(s) to appear on Deed *
  Purchaser's Social Security Number(s) *

Mortgage Lender

Lender *
  Lender Contact Name *
Lender Phone
  Lender E-mail

Homeowners Information

Insurance Company Name *
Agent's Name *
  Agent's Phone Number *

Buyer's Agent Information

Agent's Name *
  Agent's Company *
Agent's Phone No. *
  Agent's Commission on sale *
What is the Commission split?
Selling Agent %    Listing Agent %    Selling Bonus %   
Does Buyer want attorney to order Survey?
Yes   No
Was termite inspection performed?
Yes   No
If yes, please fax a copy of the Termite inspection AND invoice.
Please fax us any invoices which are to be paid at closing.

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