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Home Data Record (HDR)

Name of Person Completing Form *

First

Last

Email of Person Completing Form *

Agent Information

Agent Name *

Office Name *

Office Address *

Address Line 1

City

State

Zip Code

Agent Phone *

Agent Email *

Enrolled Home Buyer Information

Buyers Name *

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

Others Involved in Transaction

Seller Name

Seller Phone

Seller Email

Cooperating Agent Name

Cooperating Agent Phone

Cooperating Agent Email

Current Appliance/ System Inventory

This HDR must be completed as thoroughly as possible. If appliance(s) are not part of the sale, please indicate such with a NPS. If the information regarding the appliance(s) is not accessible or available, please indicate such with a N/A.

Appliances *

Furnace
A/C
Heat Pump
Water Heater
Refrigerator
Oven
Cook Top/ Range
Dishwasher
Built-In Microwave

Additional Furnace?

Yes
No

Additional A/C?

Yes
No

Furnace Brand *

Furnace Model Number and Color

Additional Furnace Brand *

Additional Furnace Model Number and Color

A/C Brand *

A/C Model Number and Color

Additional A/C Brand *

Additional A/C Model Number and Color

Heat Pump Brand *

Heat Pump Model Number and Color

Water Heater Brand *

Water Heater Model Number and Color

Refrigerator Brand *

Refrigerator Model Number and Color

Oven Brand *

Oven Model Number and Color

Cook Top/ Range Brand *

Cook Top/ Range Model Number and Color

Dishwasher Brand *

Dishwasher Model Number and Color

Built-In Microwave Brand *

Built-In Microwave Model Number and Color

Was an inspection completed?

Yes
No

Was Seller's Coverage created for this property during Listing?

Yes
No

Which party is paying for the Closing warranty?

Warranty/ Listing # (if available)

Enroll: 720.531.6723 | www.2-10.com/agent/

2-10 HBW

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