Reverse Order Intake Form EXCHANGE CLOSE DATE*EXCHANGE CLOSE DATE MM slash DD slash YYYY In-Take Date* MM slash DD slash YYYY In-Take By*In-Take's Email* Referring Regional Office?* Central Hawaii Midwest NoCal Northeast Northwest SoCal Southern SouthwestReferral Date MM slash DD slash YYYY Referring PersonReferral SourceChoose oneCPARE AgentAttorneySettlement AgentCommercial BrokerRepeatClientOtherExchange Type* Delayed (D) Delayed BTS (DBTS) Relinquished Parked (R1) Replacement Parked (R2) Reverse BTS (RBTS)FEE QUOTEDAccomodation Fee ($) + LLC Reimbursement ($) + Additional Fees ($) - Discounts ($) Interest Option 10 Option 9 OtherOther - InterestSpecial Banking Qualified Escrow Qualified Trust OtherOther - Special BankingAdditional Relinquished? Yes# Additional RLQ+ Additional RLQ Fee Quoted ($) Additional Replacement? Yes# Additional RPL+ Additional RPL Fee Quoted ($) TOTAL FEE QUOTEDTOTAL FEE QUOTED $0.00 HiddenLESS Discounts TESTLLC INFOLLC NameLLC Formation Shelf Custom IPX1031 Formed Custom Client FormedState of Formation CO OtherState of FormationEXCHANGER INFOName First Last EntityState of FormationVerified Spelling* Yes NoTax ID NumberMain Point of Contact (if not Exchanger) First Last Relation to ExchangerMain Contact's PhoneMain Contact's Email Exchanger Legal Address / PhoneExchanger Legal Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Exchanger PhoneExchanger Email Exchanger Alternative Address / PhoneHave alternative address / phone? YesAlternative Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Alternative Contact InfoPhoneEmail TAX ADVISORType of AdvisorCompanyName First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneFaxEmail THIRD PARTY LENDERLender Company NameLender Contact NameLender Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneFaxEmail Confirm lender provided with non-recourse language Yes NoRelinquished Property(hit + to add addl RLQ)FMVDebtEquity Replacement Property(hit + to add addl RPL)FMVDebtEquity RELINQUISHED PROPERTYRELINQUISHED CLOSE OF ESCROW DATERELINQUISHED CLOSE OF ESCROW DATE MM slash DD slash YYYY Property Type Rental Lot/Land Multi-Housing Industrial Office Retail OtherRLQ Type - OtherName of PropertyProperty Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Tax Parcel No.CountyDate of Contract MM slash DD slash YYYY Coop Clause Yes NoCurrent Tenants Yes NoDoes Exchanger Own 100%? Yes NoWhat % OwnedIf 'No' confirm partnership discussed* Yes NoHow Long HeldEnvironmental Reports Available? Yes NoAre there open recommendations? Yes NoAdditional Relinquished Property? Yes NoRELINQUISHED CLOSE OF ESCROW DATE RLQ2RELINQUISHED CLOSE OF ESCROW DATE RLQ2 MM slash DD slash YYYY Property Type RLQ2 Rental Lot/Land Multi-Housing Industrial Office Retail OtherRLQ Type - Other RLQ2Name of Property RLQ2Property Address RLQ2 Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Tax Parcel No. RLQ2County RLQ2Date of Contract RLQ2 MM slash DD slash YYYY Coop Clause RLQ2 Yes NoCurrent Tenants RLQ2 Yes NoDoes Exchanger Own 100%? RLQ2 Yes NoWhat % Owned RLQ2If 'No' confirm partnership discussed RLQ2* Yes NoHow Long Held RLQ2Environmental Reports Available? RLQ2 Yes NoAre there open recommendations? RLQ2 Yes NoCloser - Relinquished PropertyRLQ Closer NameRLQ Closer CompanyRLQ Closer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code RLQ Closer PhoneRLQ CLoser FaxRLQ Closer Email RLQ Close Date MM slash DD slash YYYY RLQ File numberCalled for Docs? Yes NoBuyer - Relinquished PropertyBuyer Name First Last Is Buyer a Related Party? Yes NoREPLACEMENT PROPERTYREPLACEMENT CLOSE OF ESCROW DATEREPLACEMENT CLOSE OF ESCROW DATE MM slash DD slash YYYY Property Type RPL Rental Lot/Land Multi-Housing Industrial Office Retail OtherRPL Type - Other RPLName of Property RPLRPL Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Tax Parcel No. RPLCounty RPLDate of Contract RPL MM slash DD slash YYYY Coop Clause RPL Yes NoCurrent Tenants RPL Yes NoDoes Exchanger Own 100%? RPL Yes NoWhat % OwnedIf 'No' confirm partnership discussed RPL* Yes NoHow Long Held RPLEnvironmental Reports Available? RPL Yes NoAre there open recommendations? RPL Yes NoAdditional Replacement Property? Yes NoREPLACEMENT CLOSE OF ESCROW DATE RPL2REPLACEMENT CLOSE OF ESCROW DATE RPL2 MM slash DD slash YYYY Property Type RPL2 Rental Lot/Land Multi-Housing Industrial Office Retail OtherRPL Type - Other RPL2Name of Property RPL2RPL2 Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Tax Parcel No. RPL2County RPL2Date of Contract RPL2 MM slash DD slash YYYY Coop Clause RPL2 Yes NoCurrent Tenants RPL2 Yes NoDoes Exchanger Own 100%? RPL2 Yes NoWhat % Owned RPL2If 'No' confirm partnership discussed RPL2 Yes NoHow Long Held RPL2Environmental Reports Available? RPL2 Yes NoAre there open recommendations? RPL2 Yes NoImprovements to be Constructed - Replacement PropertyType of Improvements to be constructedValue of Improvements at day 180 ($)General Contractor NameRelated? Yes NoCloser - Replacement PropertyCloser CompanyCloser NameCloser Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Closer PhoneCloser FaxCloser Email Called for Docs Yes NoFile No.Seller - Replacement PropertyRPL Seller NameNumberIs RPL Buyer a Related Party? Yes NoNotes / Additional Info
