Seller Input Screen

Agent Information:
	*Agent Name
	Agent Company
	*Street Address
	*City
	*State	-- Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	*Zip
	*Phone	--
	*Fax	--
Seller Information:
	*Seller Name
	*Street Address
	*City
	*County	-- Select a State --
	*State	-- Select -- Ohio	*Zip
*Estimated Closing Date //  (mm/dd/yyyy)  *Selling Price $      Total Existing Mortgages $
Tax Information:
	Annual Taxes $
	First Half	Paid   Not Paid
	Second Half	Paid   Not Paid
Commissions:
	Listing Broker	%    x    $  +   %    x    $
	Selling Broker	%    x    $  +   %    x    $
Standard Fees:
	Title Examination Escrow/Closing Fee       (with the purchase of Title Insurance only) Courier/Overnight Fee Title Insurance Binder Update/Filing Fee Closing Protection Coverage-Lender		$250.00 $0.00 $0.00 $50.00 $50.00 $35.00
Optional Fees:
These are optional fees and will only be charged if deemed necessaryl
	Deed Preparation---- $10.00 Mobile Closing---- $100.00
Additional Fees:
	Termite Inspection	$
	Home Warranty	$
	Administrative Fees	$
	Costs Paid By Seller	$
Miscellaneous Fees:
Description: Amount $  $ $
This is an estimate only. Commerce Land Title Agency, LLC, an Ohio limited liability company dba Commerce Title Company, and/or its affiliated companies (collectively, "Commerce") are providing this information based on normal and customary fees and are to be used for reference purposes only. The actual amounts will vary based on the terms of the purchase contract, lender institution or other vendors associated with the settlement process. This estimate is from sources believed to be reliable and should not be construed as a commitment or guarantee by Commerce as to the final costs of the transaction. The actual settlement costs will be shown on the HUD-1 Settlement Statement at the time of closing.