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Application form
Part 1: Information about you and your agency
Login details
Choose username (cannot be changed later)
New password
Agency details
Agency name
Agency real estate license number
Company ACN or ABN
Are you trading as a company or trust?
No
Yes
Company name
Names of directors
Trust Name and ABN
Agency office manager name
Agency office manager email
Agency address
Suburb
State
- Select -
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Postcode
Agency phone
Agency email
Agency website
Number of sales agents
Years agency operated
Is there a rent roll?
No
Yes
Rent roll owned by (entity name)
Number of properties
Bank details
Facilities with a bank?
No
Yes
Overdraft limit
Loans
Bank name
Account name
BSB
Account number
Applicant details
First name
Middle name
Last name
Position
Date of birth
Driver's licence number
Real estate licence number
Home address
Suburb
State
- Select -
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Postcode
Years at this address
Do you own or rent your home?
Rent
Own
Home phone
Mobile phone
Primary / your main communication email address
Years with agency
Emergency contact person
Emergency contact relationship (e.g. spouse)
Emergency contact primary phone
Emergency contact home address
Is there a second principal/director?
No
Yes
Applicant 2 details
First name
Middle name
Last name
Position
Date of birth
Driver's licence number
Real estate licence number
Home address
Suburb
State
- Select -
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Postcode
Years at this address
Do you own or rent your home?
Rent
Own
Home phone
Mobile phone
Primary email address
Years with agency
Emergency contact person
Emergency contact relationship (e.g. spouse)
Emergency contact primary phone
Emergency contact home address
Other details
How did you hear about our service?
Do you have colleagues who'd be interested in our services?
No
Yes
Have you dealt with a commission advance company before?
No
Yes
Please tell us who
Part 2: Information about the property and sale
This part is optional; would you like to request your first commission advance now?
No
Yes
Sale details
Address of property sold
Suburb
State
- Select -
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Postcode
Date agency authority
Date contract signed
Date contract unconditional
Date final settlement
Contract price
Deposit amount
Deposit details
Held in agency trust account
Held in solicitor trust account
Deposit bond
Released to vendor
Other
Conjunctional or subcontractor?
No
Yes
Conjunctional split: Percentage to you
Commission details
Net share of commission (splits, fees & expenses, ex GST)
Unpaid vendor marketing (ex GST)
Subtotal
GST
Total entitlement
Advance amount sought (leave blank for maximum amount)
Comments related to commission
Please confirm the following:
I/We have read and accepted the
Terms of Service
.
I/We have read and accepted the
Privacy Policy
.
I/We certify the information provided in the Application is true and correct. I/We acknowledge any inentional or negligent misrepresentations of the information contained herein may result in civil liability and/or criminal penalties and liability for damages to Express Commission Australia.
I/We acknowledge the principals, directors, shareholder, and proprietors consent and agree to guarantee my/our performance.
When new Advances are requested: No other person is entitled to my/our share of the Commission.
When new Advances are requested: I/We absolutely and unconditionally offer to sell, transfer, and assign my/our legal and beneficial right, title, and interest in and to the Commission to Express Commission Australia and grant a Security Interest in the Commission to Express Commission Australia.
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