Closing Bill Request Form Miuccio Group Agent * First Name Last Name Cooperating broker/agent Name Transfer agent incentive. MG Agent who refers transfer agent will receive 10% of all Miuccio Group collected splits for as long as that agent stays at MG. (Max $2,000/year). First Name Last Name Do you think this agent would be a good fit at Miuccio Group? Yes No Let's talk about it first Client Name First Name Last Name Address (Number & Street) Source * Agent Referral Internet/Social Media Lender Referral Listing Open House Outbound Prospecting Past Client Past Client Referral SOI SOI Referral Representing * Buyer Seller Dual Agency Renter Was a PCD Signed? * Yes No Total Purchase Price (Including Concessions) * $ Loan Type Conventional Cash FHA VA Other Attorney * First Name Last Name Lender (if applicable) First Name Last Name Inspector (if applicable) First Name Last Name Additional Instructions Thank you!
