Application And Order Form - Sellers Shield
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1Application and Order Form
Seller confirms that the Property is an owner-occupied residence. Seller confirms his/her agreement to purchase a legal
services contract from Sellers Shield. In reliance upon the execution of this Application, Sellers Shield shall provide Seller with
access to information and online resources regarding the sale and closing process. At the closing of the Property, Seller agrees
to execute a Sellers Shield Agreement (“Agreement”) and pay $240.00 to Sellers Shield. The fee is only payable upon the sale
of the Property by Seller. The terms of the Agreement will begin on the date of the Closing, and will continue for 2 years after
the Closing. Certain important terms, conditions, definitions and exclusions apply and are detailed in the Agreement, a copy of
which can be obtained from your listing agent or from Sellers Shield. Seller directs escrow agent to distribute $240 to Sellers
Shield along with a copy of the Agreement to Sellers Shield’s address below.
Seller(s) Information:
Listing Agent Information:
____________________________________________
__________________________________
Name(s):
Listing Agent Name:
_________________________________________
_________________________________________
(“Seller(s)”)
Agent Email:
_______________________________________
Address of Property for Sale:
Agent Lic. No.:
___________________________________________________
Title Company Information:
__________________________________________
________________________________________
(“Property”)
Escrow Agent:
_______________________________________
Mailing Address after closing:
Title Company:
_____________________________________________________
When complete, return to
_____________________________________________________
Sellers Shield Contact Information:
______________________________________________
(844) 7-4-SHIELD / (844) 747-4435
Email(s):
2301 S. Capital of Texas Highway, Building H
_____________________________________________________
Austin, Texas 78746
Fax: (844) 245-8015
________________________________________
Phone Number:
For additional information please visit our website at:
By signing below, Seller agrees to the terms of the Application:
or email us at .
___________________________________________________
X
To obtain access to the password-protected seller’s disclosure
___________________________________________________
X
notice instructional video, online resources and FAQ, please call
________________________________________________
Date:
(844)747-4435.
:
I decline the protection of a Sellers Shield Agreement
Seller
Seller
Legal service contract companies and their sales representatives are regulated by the Texas Department of Licensing and Regulation. You may contact the Department at
P.O. Box 12157, Austin, TX 78711, 512-463-6599, 800-803-9202, or at legalservicecontract@license.state.tx.us.
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