Supra Lockbox Transfer Form I do hereby request the following Supra Lockboxes be transferred to the individual named below. I certify that I am the rightful owner of the Lockboxes being transferred. Lockbox Serial Number
Lockbox Serial Number
1. _____________________________
6. _____________________________
2. _____________________________
7. _____________________________
3. _____________________________
8. _____________________________
4. _____________________________
9. _____________________________
5. _____________________________
10._____________________________
_________________________________________ Name of transferring owner
__________________ Agent ID
_________________________________________ Office/Firm Name
__________________ Phone Number
_________________________________________ Signature (original owner or Manager)
__________________ Date
======================================================================= ď‚€ The original lockbox owner cannot be located. Reason Agent cannot be located (ie. Moved, deceased) _______________________________ Please provide as much information above as possible. Due diligence will be performed to determine if the lockboxes meet the requirements to be re-registered in your name. ======================================================================= As the new owner of the Supra Lockboxes listed above, I assume all rights and obligations for the Lockboxes. _________________________________________ Name of receiving owner (please print)
__________________ Agent ID
_________________________________________ Office/Firm Name
__________________ Phone Number
_________________________________________ Signature
__________________ Date
This completed form MUST be returned to the local Supra office, faxed to 513-821-8544 or emailed to supraadmin@cincymls.com for processing. Lockbox transfers will NOT be completed without this form.