Enter the address of the property you are listing
Street Address Line 1 Street Address Line 2 City Country Name On Card Email Field Credit Card Number Credit Card Expiration CVC Code (usually on back of card) Owner 1 – First Name Owner 1 – Last Name Owner 1 – Phone Number Owner 1 – Email Address Owner 1 – Birth Date Is the Owner US Citizen?Yes No Owner 2 – First Name Owner 2 – Last Name Owner 2 – Phone Number Owner 2 – Email Address Owner 2 – Birth Date Is the Owner US Citizen?Yes No Mailing Address City State Zip Code This property is in aTrust Estate None of the Above Is the property part of a HOA or community Assn?Yes No Was the property built prior to 1978?Yes No Detail any and all defects of the property Listing Price (Sale Price) How did you determine the price for your home? Are you purchasing a new home?Yes No Reason for selling? Time frame for selling Mortgage Balance (if any) Commission to Selling Office/Agent2% of sale price 5% of sale price 10% of sale price How will potential clients view your property?Shown by owner Garage Door Code Lock box Code Other Is this home in a gated community?Yes No Does your HOA have any sign restrictions?Yes No How did you hear about us?Google Facebook Referral from one of our clients Other Next
Limited Service Listing Agreement
Type Seller’s Name Date this form being signed Seller’s Signature
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Residential Listing Data
How many floors are in the property?One Floor Two Floors Three or more Multi/Split Total Number of Floors Floor Number Homestead?Yes No CDD?Yes No CDD-If Yes, enter amount Private PoolYes No Pool Dimensions Pool FeaturesAbove Ground Diving Board Gunite / Concrete Indoor Outside Bath Access Salt Water Solar Cover Tile Auto Cleaner Fiber Optic Lighting Heated Infinity Edge Pool Alarm Screen Enclosure solar Heat Vinyl Child Safety Fence Fiber Glass In Ground Lighting Pool Sweep Self Cleaning Solar Power Pump Other Private SpaYes No Spa FeaturesAbove Ground Heated In Ground Swim Spa Other Property Style1/2 Duplex Dock-Rackominium Mobile Home Villa Condo-Hotel Farm Single Family Residence Condominium Manufactured Home Townhouse Front Exposure (What direction East does the front door face?)East North Northeast Northwest South Southeast Southwest West Property AttachedYes No New ConstructionsYes No ViewCity Garden Golf Course Greenbelt Mountains Park Pool Tennis Court Trees/Woods Water Lot FeaturesCoastal Construction Line Conservation Area Corner Lot Cul-de-sac Drainage Canal Flag Lot Flood Insurance Required Food Zone Greenbelt Hilly Historic District In City Limits In County Irregular Lot Key Lot Level / Flat Mountainous Near Golf Course Near Marina Near Public Transport On Golf Course Oversized Lot Pasture/Agricultural Sidewalks Street Brick Street Dead-Ends Street One Way Street Paved Street Private Street Unpaved Tip Lot Unincorporated Zoned for Horses Other StructureAdditional Single Family Home Barn(s) Boathouse Corral(s) Finished RV Port Gazebo Greenhouse Guest House Kennel/Dog Run Outdoor Kitchen Shed(s) Stable(s) Storage Tennis Court(s) Workshop Other VegetationBamboo Fruit Trees Mature Lanscaping Oak Trees Trees Landscaped Wooded Patio and/or Porch FeaturesCovered Deck Enclosed Front Porch None Patio Porch Rear Porch Screened Side Porch Wrap Around Other FoundationBasement Crawlspace Slab Stem Wall Stilt/On Piling Exterior ConstructionAsbestos Block Brick Cement Siding Concrete ICFS (Insulated Concrete Forms) Log Metal Frame Metal Siding Stone Structurally Insulated Panel Stucco Tile-Up Walls Vinyl Siding Wood Frame Wood Frame (FSC) Wood Siding Other RoofBuilt Up Concrete Membrane Metal Roof Over Shake Shingle Slate Tile Other Exterior FeaturesBalcony Dog Run Fenced rench Doors Gray Water Hurricane Shutters Irrigation System Lighting Outdoor Kitchen Outdoor Grill Outdoor Shower Rain Barrel/Cistern(s) Rain Gutters Satellite Dish Sauna Sidewalk Sliding Doors Sprinkler Metered Storage Tennis Court(s) Other GarageYes No Attached GarageYes No Garage Spaces Garage Dimensions CarportYes No Carport Spaces Garage/Parking FeaturesAlley Access Assigned Parking Bath In Garage Boat Parking Circular Drive Common Covered Parking Driveway Electric Vehicle Charging Stations Garage Door Opener Garage Faces Rear Garage Faces Side Golf Cart Garage Golf Cart Parking Guest Parking None Off Street Parking On Street Parking Open Parking Oversized Parking Pad Portico Reserved RV Carport RV Garage Split Garage Tandem Parking Underground Valet Workshop in Garage Other Number of Bedrooms Number of Full Baths Number of Half Baths FireplaceYes No Fireplace DescriptionDecorative Electric Family Room Free Standing Gas Living Room Master Bedroom Non Wood Burning Other Room Wood Burning Square feet heated Source for the heated square feet amountAppraisal Builder Measured Owner Provided Public Records Total square feet Source for the total square feet amountAppraisal Builder Measured Owner Provided Public Records Additional RoomsAttic Bonus Room Breakfast Room Separate Den/Library/Office Family Room Florida Room Formal Dining Room Separate Formal Living Room Separate Great Room Inside Utility Interior In-Law Apt Loft Media Room Storage Rooms Appliances IncludedBar Fridge Built-in Oven Convection Oven Cooktop Dishwasher Disposal Dryer Electric Water Heater Exhaust Fan Freezer Gas Water Heater Ice Maker Indoor Grill Kitchen Reverse Osmosis System Microvawe None Range Range Hood Refrigerator Solar Hot Water Solar Hot Water Rented Tankless Water Heated Trash Compactor Washer Water Filtration System Water Purifier Water Softener Whole House R.O. System Wine Refrigerator Other Interior FeaturesAttic Fan Attic Ventilator Built in Features Cathedral Ceiling(s) Ceiling Fan(s) Central Vacuum Coffered Ceiling(s) Crown Molding Dry Bar Dumbwaiter Eating Space in Kitchen Elevator High Ceiling(s) In Wall Pest System Kitchen/Family Room Combo L Dining Living Room/Dining Room Combo Master Bedroom Downstairs Open Floorplan Pest Guard System Sauna Skylights Solid Surface Counters Solid Wood Cabinets Split Bedroom Stone Counters Thermostat Thermostat Attic Fan Tray Ceiling(s) Vaulted Ceiling(s) Walk-in closet(s) Wet Bar Window Treatments Other FurnishingsFurnished Optional Partial Turnkey Unfurnished Accessibility FeaturesAccessible Approach Accessible Bedroom Accessible Living Areas Accessible Closets Accessible Common Room Accessible Doors Accessible Electrical and Environmental Controls Accessible Elevator Installed Accessible Entrance Accessible for Hearing Impaired Accessible Full Bath Accessible Guest Bathroom Accessible Hallway(s) Accessible Kitchen Accessible Kitchen Appliances Accessible Stairway Accessible Washer/Dryer Ceiling Track for Lift Chair Central Living Area Exterior Wheelchair Lift Grip-Accessible Features Handicap Modified Stair Lift Laundry FeaturesCorridor Access Inside In Garage In Kitchen Laundry Chute Laundry Closet Laundry Room None Outside Upper Floor Other Window FeaturesBlinds Drapes Energy Star Windows Insulated Windows Low Emissivity Windows Rods Shades Shutters Solar Screens Thermal Windows Window Treatments Floor Covering(s)Bamboo Brick/Stone Carpet Ceramic Tile Concrete Cork Engineered Hardwood Epoxy Forestry Stewardship Certified Granite Laminate Linoleum Marble Parquet Porcelain Tile Quarry Tile Reclaimed Wood Recycled/Composite Flooring Slate Terrazzo Tile Travertine Vinyl Wood Other Security FeaturesClosed Circuit Camera(s) Fire Alarm Fire Sprinkler System Gated Community Key Card Entry Medical Alarm Security Fencing/Lighting/Alarms Secured Garage / Parking Security Gate Security Lights Security System Security System Leased Security System Owned Smoke Detector(s) UtilitiesBB/HS Internet Available Cable Available Cable Connected Electricity Available Electricity Connected Emergency Power Fiber Optics Fire Hydrant Mini Sewer Natural Gas Available Natural Gas Connected Public Sewer Available Sewer Connected Solar Sprinkler Meter Sprinkler Recycled Sprinkler Well Street Lights Telephone Nearby Underground Utilities Water Available Water – Multiple Meters Water Nearby WaterCanal/Lake for Irrigation None Private Public Well Well Required SewerAerobic Septic None Private Sewer Public Sewer Septic Needed Septic Tank Other Heating and FuelBaseboard Central Electric Exhaust Fans Heat Pump Heat Recovery Unit Natural Gas None Oil Partial Propane Radiant Ceiling Reverse Cycle Solar Space Heater Wall Furnace Wall Units / Window Unit Zoned Other Air ConditioningCentral Air Humidity Control Mini-Split Unit(s) None Wall/Window Unit(s Zoned Other Water AccessYes No Water Access – if yes aboveBay/Harbor – Full Bay/Harbor – Partial Bayou Beach Canal Creek Gulf/Ocean – Full Gulf/Ocean – Partial Gulf/Ocean to Bay Intracoastal Waterway Lagoon/Estuary Lake Lake – Chain of Lakes Marina Pond River Water ExtrasYes No Water Extras – if yes aboveAssigned Boat Slip Boat Ramp – Private Boathouse Boats – None Allowed Bridges – Fixed Bridges – No Fixed Bridges Davits Dock – Composite Dock – Concrete Dock – Covered Dock – Open Dock – Slip 1st Come Dock – Slip Deeded Off Site Dock – Slip Deeded On Site Dock – Wood Dock with Electric Dock without Electric Dock with Water Supply Dock without Water Supply Fishing Pier Lift Lift-Covered Lock Minimum Wake Zone No Wake Zone Powerboats – None Allowed Private Lake Dues Required Riprap Sailboat Water Seawall – Concrete Seawall – Other Skiing Allowed Water FrontageYes No Water Frontage type – if yes aboveBayou Canal – Brackish Canal – Fresh Lake – chain of lakes Bay/Harbor Gulf/Ocean to Bay Marina Beach – Private Beach – Public Intracoastal Waterway Pond Lake Creek Lagoon/Estuary River Brackish Water Number of feet of water frontage if yes above Water Name(s) Additional Water InformationBack Next
Owner First & Last Name Owner Phone Number Tenant First & Last Name Tenant Phone Number Ownership TypeCondominium Co-op Fee Simple( This accounts for almost all non-condominium MLS listings) Fractional Home WarrantyYes No Existing Lease or TenantYes No Monthly Rental Amount Lease / Rental TypeMonth to Month Weekly Annually Seasonally Days Notice to Tenant required if Not Renewing15 Days 30 Days 60 Days 90 Days End Lease Date Public Remarks Private Realtor Only Remarks Showing Instructions24-Hour Notice Appointment Only Call Before Showing Contact Call Center Call Owner Call Tenant Gate Code Required Lock Box – Combination Lock Box – Coded Lock Box – Electronic Occupied Pet On Premises See Remarks Under Construction Vacant Driving Directions Type Seller’s Name Seller’s SignatureBack Next
Affiliated Business Disclosure
Company
HUD-1 Description/Line Designation
Estimate of Range of Charges Generally Made by Provider (1.)
Acknowledgement of Receipt of Disclosure
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Seller’s Property Disclosure – Residential
Seller makes the following disclosure regarding the property described as: The Property isOwner Occupied Tenant Occupied Unoccupied If unoccupied, how long has it been since Seller occupied the Property? 1. Structures; Systems; Appliances A. Are the structures including roofs; ceilings; walls; doors; windows; foundation; and pool, hot tub, and spa, if any, structurally sound and free of leaks?YES NO DON'T KNOW B. Is seawall, if any, and dockage, if any, structurally sound?YES NO DON'T KNOW C. Are existing major appliances and heating, cooling, mechanical, electrical, security, and sprinkler systems, in working condition, i.e., operating in the manner in which the item was designed to operate?YES NO DON'T KNOW D. Does the Property have aluminum wiring other than the primary service line?YES NO DON'T KNOW E. Are any of the appliances leased? If yes, which ones:YES NO DON'T KNOW List all leased appliances, if any F. If any answer to questions 1(A) – 1(C) is no, please explain: G. The age (in years) of the A/C unit(s) 2. Termites; Other Wood-Destroying Organisms; Pests A. Are termites; other wood-destroying organisms, including fungi; or pests present on the Property or has the Property had any structural damage by them?YES NO DON'T KNOW B. Has the Property been treated for termites; other wood-destroying organisms, including fungi; or pests?YES NO DON'T KNOW C. If any answer to questions 2(A) – 2(B) is yes, please explain: A. Has past or present water intrusion affected the Property?YES NO DON'T KNOW B. Have past or present drainage or flooding problems affected the Property?YES NO DON'T KNOW C. Is any of the Property located in a special flood hazard area?YES NO DON'T KNOW D. Is any of the Property located seaward of the coastal construction control line?YES NO DON'T KNOW E. Does your lender require flood insurance?YES NO DON'T KNOW F. Do you have an elevation certificate? If yes, please attach a copy.YES NO DON'T KNOW G. If any answer to questions 3(A) – 3(D) is yes, please explain: 4. Plumbing A. Have you ever had a problem with the quality, supply, or flow of potable water?YES NO DON'T KNOW B. Do you have a water treatment system?YES NO DON'T KNOW C. Are any septic tanks, drain fields, or wells that are not currently being used located on the Property?YES NO DON'T KNOW D. Have there been any plumbing leaks since you have owned the Property?YES NO DON'T KNOW E. Are any polybutylene pipes on the Property?YES NO DON'T KNOW F. Do you have asewer or septic system If septic system, describe the location of each: G. If any answer to questions 4(A) – 4(E), is yes, please explain: 5. Roof and Roof-Related Items A. To your knowledge, is the roof structurally sound and free of leaks?YES NO DON'T KNOW B. Has the roof ever leaked during your ownership?YES NO DON'T KNOW C. To your knowledge, has there been any repair, restoration, replacement indicate full or partial) or other work undertaken on the roof?YES NO DON'T KNOW D. Are you aware of any defects to the roof, fascia, soffits, flashings or any other component of the roof system?YES NO DON'T KNOW E. The age of the roof in years is F. If any answer to questions 5(A) – 5(D) is yes, please explain: 6. Pools; Hot Tubs; Spas A. Has an in-ground pool on the Property been demolished and/or filled?YES NO DON'T KNOW B. If the Property has a swimming pool, hot tub, or spa that received a certificate of completion on or after October 1, 2000, indicate the existing safety feature(s):enclosure that meets the pool barrier requirements approved safety pool cover required door and window exit alarms required door locks none 7. Sinkholes A. Does past or present settling, soil movement, or sinkhole(s) affect the Property or adjacent properties?YES NO DON'T KNOW B. Has any insurance claim for sinkhole damage been made? If yes, was the claim paid?YES NO DON'T KNOW If the claim was paid, were all the proceeds used to repair the damage?YES NO DON'T KNOW C. If any answer to questions 7(A) – 7(B) is yes, please explain: 8. Homeowners’ Association Restrictions; Boundaries; Access , Roads A. Is membership in a homeowner’s association mandatory or do any covenants, conditions or restrictions (CCRs) affect the Property? (CCRs include deed restrictions, restrictive covenants and declaration of covenants.)YES NO DON'T KNOW B. Are there any proposed changes to any of the restrictions?YES NO DON'T KNOW C. Are any driveways, walls, fences, or other features shared with adjoining landowners?YES NO DON'T KNOW D. Are there any encroachments on the Property or any encroachments by the Property’s improvements on other lands?YES NO DON'T KNOW E. Are there boundary line disputes or easements affecting the Property?YES NO DON'T KNOW F. Are you aware of any existing, pending or proposed legal or administrative action affecting homeowner’s association common areas (such as clubhouse, pools, tennis courts or other areas)?YES NO DON'T KNOW G. Have any subsurface rights, as defined by Section 689.29(3)(b), Florida Statutes, been severed from the Property? If yes, is there a right of entry?YES NO DON'T KNOW H. Are access roadsPublic Private If private, describe the terms and conditions of the maintenance agreement: 1. If any answer to questions 8(A) – 8(G) is yes, please explain: 9. Environmental A. Was the Property built before 1978? If yes, please see Lead-Based Paint Disclosure.YES NO DON'T KNOW B. Does anything exist on the Property that may be considered an environmental hazard, including but not limited to, lead-based paint; asbestos; mold; urea formaldehyde; radon gas; methamphetamine contamination; defective drywall; fuel, propane, or chemical storage tanks (active or abandoned); or contaminated soil or water?YES NO DON'T KNOW C. Has there been any damage, clean up, or repair to the Property due to any of the substances or materials listed in subsection (b) above?YES NO DON'T KNOW D. Are any mangroves, archeological sites, or other environmentally sensitive areas located on the Property?YES NO DON'T KNOW E. If any answer to questions 9(B) – 9(D) is yes, please explain: 10. Governmental, Claims and Litigation A. Are there any existing, pending or proposed legal or administrative claims affecting the Property?YES NO DON'T KNOW B. Are you aware of any existing or proposed municipal or county special assessments affecting the Property?YES NO DON'T KNOW C. Are you aware of the Property ever having been, or is it currently, subject to litigation or claim, including but not limited to, defective building products, construction defects and/or title problems?YES NO DON'T KNOW D. Have you ever had any claims filed against your homeowner’s Insurance policy?YES NO DON'T KNOW E. Are there any zoning violations or nonconforming uses?YES NO DON'T KNOW F. Are there any zoning restrictions affecting improvements or replacement of the Property?YES NO DON'T KNOW G. Do any zoning, land use or administrative regulations conflict with the existing use of the Property?YES NO DON'T KNOW H. Do any restrictions, other than association or flood area requirements, affect improvements or replacement of the Property?YES NO DON'T KNOW I. Are any improvements located below the base flood elevation?YES NO DON'T KNOW J. Have any improvements been constructed in violation of applicable local flood guidelines?YES NO DON'T KNOW K. Have any improvements to the Property, whether by your or by others, been constructed in violation of building codes or without necessary permits?YES NO DON'T KNOW L. Are there any active permits on the Property that have not been closed by a final inspection?YES NO DON'T KNOW M. Is there any violation or non-compliance regarding any unrecorded liens; code enforcement violations; or governmental, building, environmental and safety codes, restrictions or requirements?YES NO DON'T KNOW N. If any answer to questions 10(A) – 10(M) is yes, please explain: 11. Foreign Investment in Real Property Tax Act (“FIRPTA”) A. Is the Seller subject to FIRPTA withholding per Section 1445 of the Internal Revenue Code? If yes, Buyer and Seller should seek legal and tax advice regarding compliance.YES NO DON'T KNOW 12. Other Matters or Additional Comments Type Seller’s Name Seller’s Signature * Date signed *
Seller’s Update
Instructions to Seller: If the information set forth in this disclosure statement becomes inaccurate or incorrect, you must promptly notify Buyer. Please review the questions and your answers. Use the space below to make corrections and provide additional information, if necessary. Then acknowledge that the information is accurate as of date signed below. Type Seller’s Name Seller’s Signature * Date signed *Back Next
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