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AGENT INFORMATION
Agent Name:______________________________________________________________________
Date deductions are to be effective: ___________________________________________________
Agent Signature: __________________________________________________________________
Voluntary Commission Deductions
All deductions will be applied to every commission check from a closed sale. We will not apply
deductions to home warranty checks or any BPO checks due to the small amount of these
commissions. All other deductions will be applied before percentages for voluntary deductions, i.e.
referral fees, past due agent accounts, etc.
All percentages will remain in effect until notified, in writing, of the changes. To make changes,
please complete another one of these forms and submit to corporate accounting.
All disbursements must be requested in writing (or via email) and will be returned within 72 hours of
receipt of request. Email requests to Carrie Mundy, .
Tax Savings _____%
disbursed to agent based on estimated tax payment dates - on or about April 10, June 10, Sept 10 and Jan 10
Investment Account _____%
disbursed to agent upon written request
To be completed by the agent, returned to the Office Manager and forwarded to the corporate
office.
Date:_________________ New Form Revision of Current Deductions
Please indicate which deductions you wish to include and the percent applied to each.