Exchange Information Sheet

PLEASE PRINT, COMPLETE THIS FORM NEATLY AND FAX IT TO 415-332-5811.

1. Exchanger's Name(s)
(Individuals, trust, LLC, etc.) 		________________________________________________________
Home Address: ________________________________________________________
City, State and Zip: ________________________________________________________
Phone: home/office ________________________________________________________
Soc. Sec. No.(s) or Tax ID No.: ________________________________________________________
2. Address of property(ies) to be sold:
a. ________________________________________________________
b. ________________________________________________________
Buyer: ________________________________________________________
Title (Escrow) Officer: ________________________________________________________
Title Company: ________________________________________________________
Address: ________________________________________________________
City, State and Zip: ________________________________________________________
Phone: ________________________________________________________
Fax: ________________________________________________________
Escrow No.: ________________________________________________________
Escrow Close Date: ________________________________________________________
3. Address of property(ies) to be acquired:
a. ________________________________________________________
b. ________________________________________________________
Seller: ________________________________________________________
Title (Escrow) Officer: ________________________________________________________
Title Company: ________________________________________________________
Address: ________________________________________________________
City, State and Zip: ________________________________________________________
Phone: ________________________________________________________
Fax: ________________________________________________________
Escrow No.: ________________________________________________________
Escrow Close Date: ________________________________________________________

By completing and returning this Exchange Information Sheet, you hereby agree to pay in full a consulting fee of $______ on or before the first closing in the transaction but in no event later than sixty (60) days hereafter.

It is understood and agreed that the fee is nonrefundable in whole or in part and is payable whether or not any closing occurs or exchanger decides not to complete the transaction.

Dated: _____________      Signature: _____________________________

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