Mi Casa Title Services | Buyer Agent Order Form

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<div class="buyer box">
      <div class="col">
        <p class="title_section">Additional Buyer</p>
        <input name="full_name[]" type="text" id="full_name-{0}" title="full name"  />
        <input name="email[]" type="text" id="email-{0}" title="email"  />
      </div>
      <div class="col" style="margin-top:29px">
       	<input name="mobile[]" type="text"  id="mobile-{0}" title="mobile phone"  />
	    <input name="business_phone[]" type="text" id="business_phone-{0}" title="home/business phone"  />
        <span id="sn-{0}" class="hidden">
        	<input name="spouse[]" type="text"  id="spouse-{0}" title="spouse name"/>
        </span>
      </div>
   	  <div class="col last hidden" style="margin-top:24px" id="buyer_address_block-{0}">
      	<input type="text" title="mailing address" value="" id="buyer_address-{0}" name="buyer_address[]" class="buyer_address_input-{0}">
        <input type="text" title="city" value="" id="buyer_city-{0}" name="buyer_city[]" class="buyer_address_input-{0}">
        <p>
        <input type="text" title="state" value="" id="buyer_state-{0}" class="middle buyer_address_input-{0}" name="buyer_state[]">
        <input type="text" title="zip" value="" id="buyer_zip-{0}" class="short buyer_address_input-{0}" name="buyer_zip[]">
      </p>
      </div>
	  
	  <div class="col three">
		<p>Marital status of buyer 
			<select name="marital_status[]" id="marital_status-{0}" class="order_select marital_status">
				<option value=""  selected="selected">Select</option>
				<option value="Single" >Single</option>
				<option value="Married" >Married</option>
			</select>
		</p>
         <p>Will buyer(s) be attending closing? 
			 <select name="buyer_at_closing[]" id="buyer_at_closing-{0}" class="order_select">
				 <option value=""  selected="selected">Select</option>
				 <option value="Yes" >Yes</option>
				 <option value="No" >No</option>
			 </select>
		 </p>
          <p>Will buyer(s) be moving into property? 
			  <select name="buyer_moving[]" id="buyer_moving-{0}" class="order_select buyer_address_block">
				  <option value=""  selected="selected">Select</option>
				  <option value="Yes" >Yes</option>
				  <option value="No" >No</option>
			  </select>
		  </p>
	  </div>
	  
    </div>

Buyer

Marital status of buyer

Will buyer(s) be attending closing?

Will buyer(s) be moving into property?

add another buyer

Property Address

Lender/Broker

Seller or Seller's Realtor

Buyer Agent

Your Commission

Processing Fee

Buyer's Agent Order Form

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