222 South US Highway One, Suite 208G

Tequesta, FL 33469
Phone (800) 601-1649
Fax (561) 222-2034
_____________________________________________________________________________________
of Florida Atlantic

INSTRUCTIONS FOR COMMISSION ADVANCE

(Return completed forms to us by Fax or Email)
(Date)

To: (Agent)

(Real Estate Company)

(Office Fax #)

(Office Phone #)

From: Roy G. Weinberg, Owner (COMMISSION EXPRESS)

Fax # (561) 222-2034

Phone # (800) 601-1649

Number Of Pages Being Emailed or Faxed: Cover + 6

Complete, sign and email or fax the 9‘d Items to us: roy@commissionexpressfla.com

9 Application to Sell Receivable.

• Include all Documents noted in item #11 (on the APPLICATION TO SELL RECEIVABLE)

9 Certification.
• Read the statement carefully before signing.

9 Notice of Assignment.
• YOU must have your Broker sign the Notice of Assignment
• YOU must have Title Company sign the Notice of Assignment

Note 1: YOU MUST CALL THE BROKER AND THE SETTLEMENT AGENT TO CONFIRM
THAT THEY HAVE COMPLETED THIS PART OF THE APPLICATION PROCESS

Return all related documents (i.e. Copy of Contract, Letter of Loan Committment, etc.) by Email or FAX

Misc. Comments:

PLEASE MAKE SURE TO PROVIDE THE CREDIT SCORE OF THE PURCHASER.

ANYTHING LESS THAN "700" WILL PROBABLY BE UNACCEPTABLE UNLESS THERE IS A
SIGNIFICANT EARNEST DEPOSIT!

© 2007 Commission Express National, Inc. FAXCVAPP 05/07

 222 South US Highway One, Suite 208G
Tequesta, FL 33469
PHONE: (800) 601-1649
FAX: (561) 222-2034
___________________________________________________________________________________ __
APPLICATION to SELL RECEIVABLE

1. Agent Name:_______________________________________ SS# _________________________________ ! Listing Agent

" Selling Agent
Home Address: _______________________________________ Home Phone: _________________________
" Own Home
City, State, Zip: ______________________________________ Home Fax: ___________________________ " Rent Home
E-Mail: ____________________________________________ Cell Phone: _________________________________________

2. Company Name: _____________________________________ Broker/Auth. Rep. ___________________________________

Company Address: _____________________________________ Company Phone: ____________________________________

City, State, Zip: ________________________________________ Company Fax: ______________________________________

3. Years with Present Company: ________________________ Bank (Personal): _____________________________________

Year Licensed: _______________________________________ Wire #:

Account #:__________________________________________

4. Property Address: ___________________________________ Seller: _____________________________________________

Reference #: _________________________________________ Purchaser: _________________________________________

City, State, Zip: _______________________________________ BROKER EMAIL:

5. Settlement Agent: ____________________________________ Settlement Rep.: _____________________________________

Settlement Address: ____________________________________ Settlement Phone: ___________________________________

City, State, Zip: ________________________________________ Settlement Fax: ______________________________________

Settlement Email: ____________________________________

6. Lender: ___________________________________________ Loan Officer: ________________________________________

Lender Address: ______________________________________ Lender Phone: ______________________________________

City, State, Zip: _______________________________________ Lender Fax: ________________________________________

7. Final Contract Price: _________________________________ New Construction? Yes _________ No _________

8. Ratification Date: ____________________________________ Settlement Date: _____________________________________

(Date that ALL contingencies except Financing have been removed.)

9. Receivable (Agent’s Share of Commission) $_______________ Do you want to sell your entire Receivable or just part of it?
(After ALL expenses and deductions, NET amount due to you.) "Entire "Partial $_____________

10. Earnest Deposit $_________ Down Payment $______________ Settlements Pending #_____ Settled Last 12 Months #______

Listings Current #_________ Last Year’s Total Income $_____________________

11. Documents Required: X Certification
X MLS Listing Printout (Status: Under Contract / Pending / Sold)
X Notice of Assignment (Acknowledged by or letter from Settlement Agent)
FAX the completed Application together with the X’d items to 561- 222-2034 Do not FAX separately.
Declaration: I declare under penalty of perjury that each of the representations and acknowledgments contained in the Master Repurchase
and Security Agreement , Account Receivable Sale and Assignment Agreement and Certification were and remain true and correct to the
best of my information and belief. Furthermore, I acknowledge that any intentional or negligent misrepresentation of the information
contained in this Application may result in civil liability and/or criminal penalties and liability for monetary damages to Commission Express,
its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation
which I have made on this Application.
___________________________________ Date X _______________________________________ Seal (Agent)

© 1995-2007 Commission Express National, Inc. APPLICAT 03/07 www.commissionexpressfla.com

 222 South US Highway One, Suite 208G
Tequesta, FL 33469
PHONE: (800) 601-1649
FAX: (561) 222-2034
_____________________________________________________________________________________
ACCOUNT RECEIVABLE SALE AND ASSIGNMENT AGREEMENT
(Agent: Advance & Holdback to Agent)

This Account Receivables Sale and Assignment Agreement (Assignment Agreement) is made

this date ___________________________________,

between ___________________________________ (Agent)

and COMMISSION EXPRESS (CE)

Ref: Ratified contract dated _____________________ with Settlement Date ______________________

on ____________________________________________________________________ (Property Address)

___________________________________________________________________________

through ____________________________________________ (Real Estate Company)

with ______________________________________________ (Settlement Agent)

WITNESSETH
WHEREAS, Agent is a duly licensed real estate agent entitled to earn commissions (accounts receivable)
under the terms of an Independent Contractor Agreement with Real Estate Company; and
WHEREAS, Agent is entitled to an account receivable on the sale of the above referenced property; and
WHEREAS, Agent desires to sell and irrevocably assign this account receivable to CE, and to grant a
security interest to CE in certain property as more fully set forth in the Master Repurchase and Security
Agreement (Master Agreement) to secure payment of such account receivable to CE.
NOW THEREFORE, in consideration of the sum stated, receipt and sufficiency of which are hereby
acknowledged, and the mutual terms herein, the parties agree as follows:

1. The recitals above are incorporated herein.

2. Agent hereby irrevocably sells, assigns and conveys to
CE all right, title, and interest to the account receivable due
Agent on the sale referenced above in the amount of……………………$ _____________ (Receivable)
3. ← I WILL FILL IN
CE has paid and agrees to pay Agent the sum of…………………...$ _____________ (Advance)
← UPON APPROVAL!
upon execution of this Assignment Agreement, plus the sum of………$ _____________ (Holdback)
upon receipt by CE of the full amount in 2. above subject to terms and conditions contained in the Master
Agreement.
4. The account receivable being sold to CE is free and clear of any liens, claims, security interests or
other encumbrances. No defense, offset or counterclaim exists or will exist against the account receivable
and there has been and will be no agreement to discount or deduct other charges from the account
receivable, except as permitted in writing by CE.
Agent authorizes CE to file UCC Financing Statements in a form satisfactory to CE, and Agent will
reimburse CE for all expenses incurred in the filing of UCC Financing Statements, Continuation
Statements and Termination Statements.
Agent will notify CE within 5 days of Agent’s change of residence or place of business.
5. Agent acknowledges that the primary purpose underlying each transaction represented by this
Agreement is as expressly stated in Section 10 of the Master Agreement.
6. This Assignment Agreement shall be treated as an ancillary agreement to that Master Agreement
between the parties and shall be construed and enforced in conjunction therewith.
7. Agent hereby declares under penalty of perjury that Agent has read each of the recitals and terms of
this Agreement and they are true and correct to the best of Agent’s information and belief.

IN WITNESS WHEREOF, the undersigned have set their hands and seals.

X __________________________________ (Seal) X By: _______________________________ (Seal)

Agent For Commission Express

© 1998-2007 Commission Express National, Inc. ASSAGTA 03/07 www.commissionexpressfla.com

 222 South US Highway One, Suite 208G
Tequesta, FL 33469
Phone (800) 601-1649
Fax (561) 222-2034
of Florida Atlantic
_____________________________________________________________________________________
Certification
I, _____________________________________________ (Agent) ________________________ (SS#)
hereby certify to Commission Express (CE) as of this date _____________________, in order to induce
CE to purchase the Receivable stated in a certain Account Receivable Sale and Assignment
Agreement (Assignment Agreement) related to the sale of:
___________________________________________________ (Property Address), and reference herein
the definition of terms as they are referenced in the Assignment Agreement and any documentation
referenced therein, THAT:
A. Agent is solely entitled to the Receivable in the amount of $ _____________ which is free and clear
of any liens, claims, security interests or other encumbrances. I am not currently in bankruptcy.
B. Agent has in Agent’s possession a currently binding and valid contingency free contract (except
for financing) for purchase and sale of the above referenced property, including all addenda, with a
Settlement Date of
C. Funding of the Contract is to be in the form of (check one):
________ Conventional, ________ Government, ________Assumption, ________ Cash, ________ Other.
D. Agent has in Agent’s possession:
1. If a lender is involved, a lender’s preliminary qualification letter or other documentation executed
by an authorized manager of the lender stating at a minimum:
a. The Purchaser has fully completed the lender’s written loan application.
b. The Purchaser is qualified for the loan amount called for in the contract.
c. The lender is in receipt of a satisfactory credit report.
2. If a lender is not involved, written evidence of purchaser’s ability to perform under the Contract.
3. If applicable, a valid agreement showing the sales commission split among brokers.
4. If Agent is the listing agent, a signed valid listing agreement.
E. The contracted earnest money deposit of the Purchaser in the amount of $__________ has been
received in the form of cash or its equivalent and is being held by the party designated in the
Contract. The earnest money is not in the form of a note.
F. Agent is not aware of any existing impediments that may cause the Contract not to close or to be
delayed in closing beyond settlement date shown in B. above.
G. Agent has not previously authorized anyone to file an initial UCC financing statement nor has Agent
granted the right to anyone else to file an initial UCC financing statement other than Commission
Express.

AGENT HEREBY AUTHORIZES CE TO VERIFY, USING WHATEVER MEANS IT MAY WISH, THE
CLAIMS AGENT HAS MADE HEREIN. IF REQUESTED BY CE EITHER VERBALLY OR IN WRITING,
WITHOUT PRIOR NOTICE, AGENT WILL IMMEDIATELY PROVIDE TO CE ANY AND ALL OF THE
AFOREMENTIONED DOCUMENTS. ____________
initial
Agent hereby declares under penalty of perjury that Agent has read each of the recitals and terms of this Agreement and they
are true and correct to the best of Agent’s information and belief. Agent further acknowledges and understands that any
intentional or negligent misrepresentation may result in civil liability and/or criminal penalties. This may include liability for any
loss and monetary damages to CE, its agents, successors, assigns, insurers and/or any other entity or person placing a
reliance upon any misrepresentation I may have made herein.

_________________________________ (Date) X __________________________________ (Seal)

Agent
© 1998-2007 Commission Express National, Inc. AGNTCERT 03/07
 ONE-TIME DOCUMENT

BUSINESS PURPOSE CHECKLIST AND DECLARATION

Agent/Legal Entity: _________________________________________ ____________________ (Date)
Social Security #/ Federal Tax ID: _____________________________
A. Commission Express (“CE”) is in the business of purchasing accounts from real estate business professionals
that operate in the capacity as sole proprietorships, limited liability companies and corporations.
B. CE does not make loans and does not provide consumer financing.
C. CE will purchase accounts from legal entities for any purpose.
D. CE will purchase accounts from sole proprietors only so long as the advances made toward the purchase
price of the accounts are not intended primarily for personal, family or household purposes.
E. CE understands that in conjunction therewith there may be ancillary and secondary personal, family or
household purposes. However, CE must ensure that you qualify to take advantage of our services.
Accordingly, please answer the following questions:
1. Your business is operated as a ( ___ ) Corporation, ( ___ ) LLC, ( ___ ) Sole Proprietor
2. If you are a sole proprietor:
a. You conduct your business as an _____ Independent Contractor ____ Employee.
b. You have an independent contractor agreement with your real estate company. ____Yes ____No
c. You are responsible for your tax withholding and estimated tax payments. ____Yes ____No
d. You file a Form 1040 Schedule C or C-EZ tax return in order to claim business income and expenses for
tax reporting purposes. ____Yes ____No
e. The accounts you are selling are owed to your business and any funds obtained are not intended to
be used primarily for personal, family or household purposes. They will be used primarily in your
business for business and commercial purposes.
f. You intend to use the advance primarily for the following business expenses (check all that apply):
_____ office space or desk fees
_____ office supplies, copies and postage
_____ advertising and promotional materials
_____ productivity tools (computer, PDA, digital camera, etc.)
_____ client entertainment and business meals
_____ license fees, dues and memberships
_____ multi-list fees
_____ premiums for E & O coverage
_____ automobile gas, maintenance and mileage
_____ cell phone
_____ continuing education
_____ self-employment taxes
_____ business invest
_____ Other (please specify):_________________________________________
F. CE is relying on your above representations and will not purchase your account if any of these
representations are not true.
DECLARATION
I declare under penalty of perjury and obtaining money under false pretenses:
1. Each of the representations and acknowledgments made above is true and correct
2. It is my intent to use the proceeds from the sale of my accounts to CE primarily to pay for the items checked in
“f.” above for business purposes and to manage my business cash flow.
3. I warrant these representations and understand they are a material factor in CE’s decision to purchase my
accounts receivable.
4. If at any time this intent changes, I will inform CE, in writing, prior to selling any future accounts receivable to
CE.
Signed: ____________________________ Seal (Independent Contractor/ Authorized Agent for the Business)

____________________________ Printed (Independent Contractor/ Authorized Agent for the Business)

© 1998-2007 Commission Express National, Inc. BUSPURPS 06/07