Application Form

To qualify for an advance, simply fill out our 100% secure application form and submit it online, or fax it to us. No application fee is required. To speak directly to a representative, please call (888) 9-ADVANCE or (888) 923-8262.

Please note that fields with an (*) must be filled out. All of your information will be kept confidential. See our Privacy Policy.

Click here for Rental Transactions

Agent Transaction Information
Commission Information
Document Upload

Agent Transaction Information

Property Address*

Listing Expiration Date*

Listing Price

Agent’s Current Number of Active Listings (besides this one)

Agent's Current Number of Transactions Under Contract

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Agent Transaction Information
Commission Information
Document Upload

Commission Information

Agent's Estimated Net Commission after Brokerage Split

Advance Request (up to $5,000)

Does Agent have another outstanding commission advance with a different company?*

Yes

How did you hear about us?

Return Customer

Web Search

Email Marketing

Other

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Agent Transaction Information
Commission Information
Document Upload

Document Upload

Listing Agreement - Fully Executed (2 or more preferred)

Drag & Drop file or choose file

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Agent Information
Brokerage Information

Agent Information

Home Address*

Cell Phone*

Approximate Commission Earnings in the Past 12 months*

Approximate # of Closed Sales in the past 12 months*

Agent Information
Brokerage Information

Brokerage Information

Brokerage Name*

Brokerage Address*

Agent’s Commission Split % with Brokerage

Name of Supervising Broker/Commission Manager*

Email of Supervising Broker/Commission Manager*

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Choose an Option

Submit a New Pending Sale Advance

Submit a New Active Listing Advance

Additional Advance on Existing Transaction

Client Account Overview

Choose an Option

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Agent Tran. Information
Commission Information
Closing Information
Document Upload

Agent Transaction Information

Property Address*

On this transaction, Agent Represents:*

Seller

Buyer

Both

Closing Date*

Agent’s Current Number of Transactions Under Contract (besides this one)*

Agent’s Current Number of Active Listings (besides this one)*

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Agent Tran. Information
Commission Information
Closing Information
Document Upload

Commission Information

Agent's net commission for this sale after brokerage split*

Agent's commission advance request amount*

Entire Commission

Partial (Please enter only numbers)

Does Agent have another outstanding commission advance with a different company?*

Yes

How did you hear about us?

Return Customer

Web Search

Email Marketing

Other

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Agent Tran. Information
Commission Information
Closing Information
Document Upload

Closing Information

Closing/Escrow/Settlement Contact Name*

Email*

Direct Phone*

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Agent Tran. Information
Commission Information
Closing Information
Document Upload

Document Upload

Sales Agreement - Fully Executed*

Drag & Drop file or choose file

Listing Agreement (if applicable)

Drag & Drop file or choose file

Additional Documents

Drag & Drop file or choose file

Get Paid Now

Or give us a call:

(888) 923-8262 team@concordadvance.com Text us: 917-246-5017