Fillable EDO Request Enter New Doc Name

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EDO Request Enter New Doc Name

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Office of the General Counsel
Division of Real Estate
2601 Blair Stone Road
Tallahassee, Florida 32399-2202
Phone: 850.717.1193
Halsey Beshears, Secretary
Ron DeSantis, Governor
LICENSE EFFICIENTLY. REGULATE FAIRLY.
WWW.MYFLORIDALICENSE.COM
REQUEST FOR ESCROW DISBURSEMENT ORDER
(Please type or print CLEARLY)
I. PROFILE INFORMATION
Name of requesting broker______________________________________________
Street address________________________________________________________
City_________________________________ State______ Zip_____________
Name of requesting brokerage_________________________________________________
CHECK ONE OR BOTH
Listing Office Selling Office
Telephone____________________________
E-mail_______________________________
Broker license no._____________________
Name of co-broker (if any) _______________________________________________
Name of brokerage_____________________________________________________
Street address ________________________________________________________
City______________________________ State______ Zip_____________
CHECK ONE
Listing Office Selling Office
Telephone____________________________
E-mail_______________________________
Broker license no._____________________
Name of purchaser/lessee_______________________________________________
Current* street address _________________________________________________
City______________________________ State______ Zip_____________
Name of attorney (if any)_______________________________________________________
Telephone:____________________________
Other:________________________________
*Please keep us advised of any address
changes.
Name of seller/lessor___________________________________________________
Current* street address _________________________________________________
City______________________________ State______ Zip_____________
Name of attorney (if any)_______________________________________________________
Telephone:____________________________
Other:________________________________
*Please keep us advised of any address
changes.
D
irections to Broker:
1. T
he broker holding the escrow deposit must complete this form FULLY by answering each question and
attaching LEGIBLE copies of all supporting documents and correspondence. The Department of Business
and Professional Regulation will return incomplete or undocumented requests.
2. Return the completed form to the Department of Business and Professional Regulation, Division of Real
Estate, 2601 Blair Stone Road, Tallahassee, FL 32399. The preferred method of transmission is by email t
o
t
he following address:
EDO@myfloridalicense.com
3. THE REQUESTING BROKER MUST SIGN AND DATE ON PAGE THREE OF THIS FORM.
4. If the parties later elect to arbitrate, mediate, interplead or litigate this matter or if the parties arrive at a
resolution after the date of this request, the requesting broker must notify The Division of Real Estate within
10 business days.
5. Use additional sheets if necessary.
II. Funds and Financing
A. Amount of funds held by broker $___________________ B. Total purchase price/lease price $__________________
C. Funds are held in:
Listing office
trust account
Selling office
trust account
Other
(please explain in detail below)
D. Have purchaser/lessee and seller/lessee executed a sales contract or other agreement? If Yes, attach a complete, legible copy of the
executed contract or agreement with addenda/riders.
Yes No Other (Please explain in detail below)
Effective date of contract or agreement:
Date(s) Deposit(s) made to broker’s trust account:
Inspection deadline:
Deposit deadline (s):
Financing commitment deadline:
Any other non-standard contingency deadline(s):
E. If mortgage financing is involved, did purchaser make application for financing?
Yes No
If Yes, provide the information requested below:
Applications was:
Date:
Approved Denied
Reasons for denial and subsequent financial history:
(attach lender’s statement of denial if available)
A. Has purchaser/lessee requested (of you or of co-broker) the return of the deposit?
If Yes, please give date and purchaser’s/lessee’s reason for requesting such refund (attach
copies of relevant correspondence):
Date:
Reason:
Yes No
B. Has seller/lessor made demand (of you or of co-broker) for forfeiture of the deposit?
If Yes, please give date and seller’s/lessor’s reason for claiming a forfeiture
(attach copies of relevant correspondence):
Date:
Reason:
Yes No
C. Please list the names, addresses and telephone numbers of anyone who may have additional information relative to this matter. Include any
comments you feel may assist The Florida Real Estate Commission in the determination of this matter.
IV. Certification
Under penalties of perjury, I declare that I have read the foregoing and the facts alleged are true, to the best of my knowledge and belief.
All exhibits attached are true copies of the originals made by me or under my supervision. I understand that my representations have been
made for the express purpose of securing an escrow disbursement order from the Florida Real Estate Commission. I further understand
that any false statements shall subject me to the provisions of Section 475.25, Florida Statutes, and may be punishable under the
provisions of Section 837.06, Florida Statutes.
________________________ _________________________________________________________________________________
Date Signature of requesting broker
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EDO Request Enter New Doc Name

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Completed 3 July 2020

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