Listing Agent Information Form - Cobalt Settlements, LLC

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Listing Agent Information
Name*
First Last
Company*
Email*
Preferred Phone Number*
Mailing address for commission*
Street Address Address Line 2 City State ZIP Code

Property Information

Please provide the Cobalt Settlements Case File # OR Full Property Address
I would like to provide:
- Cobalt Settlements Case File #
- Full Property Address (with City, State, Zip Code)
Cobalt Settlements Case File #*
Full Property Address*
Street Address Address Line 2 City State ZIP Code
Will the Settlement be held in Cobalt's Arlington or Alexandria office?*
- Arlington
- Alexandria
HOA Name
HOA Contact Information

Power of Attorney
Will the Seller be using a power of attorney?*
- Yes
- No
Cobalt Settlements can coordinate the preparation of the power of attorney. ($125 Fee)*
- Yes, I would like Cobalt Settlements, LLC to coordinate the preparation of POA.
- No, thank you.
Name of seller granting power*
Name of person signing for seller*
Please note that all POA’s must be approved by Cobalt Settlements in advance of closing.

Commission Information

Listing Agent Commission*
Please input as a percentage
Selling Agent Commission*
Please input as a percentage
Admin Fees/Flat Commission*
Please input as a dollar amount
Special Instructions
Name
This field is for validation purposes and should be left unchanged.

Arlington Office

4600 N Fairfax Drive
Suite 104
Arlington, VA 22203

Alexandria Office

211 North Union Street
Suite 100
Alexandria, VA 22314