RE/MAX

Premier Properties
150 N. McPherson Church Rd.
Fayetteville, NC 28303

ESCROW REFUND REQUEST

PLEASE NOTE – NO FUNDS WILL BE DISBURSED WITHOUT THE PROPER

ADDRESS & BILLS (FOR CREDIT REPORTS, APPRAISALS, ETC…),
AND SIGNATURES OF BOTH BUYER AND SELLER.

Buyer(s) Name & Address:

Lot/Subdivision:
OR
Existing Address:

Amount of Escrow Funds on Deposit: $

Seller(s) Name & Address:

DISBURSE FUNDS AS FOLLOWS:

TO WHOM: AMOUNT: $ Bill Attached?

TO WHOM: AMOUNT: Bill Attached?

TO WHOM: AMOUNT: Bill Attached?

TO WHOM: AMOUNT: Bill Attached?

TOTAL AMT DISPURSED: $

REASON FOR REFUND:

BUYER Signature: Date:

SELLER Signature: Date:

Company Form 9
Requesting Agent: Date:

Company Form 9