Short Sale Counter

*Required

Account Manager


Account Manager's Name*
Account Manager's Telephone Number*
Account Manager's Email*


Referring Agent (if applicable)


Referring Agent's Name
Referring Agent's Email


Property


Subject Property Address*:


Buyer's Information - (only if required)


Buyer's Name


Lien Holder's Information - (only if required)


Lien Holder's Name
Lien Holder Position's
Counter Due Date


Terms

Additional Comments

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