Name _____________________________

Address____________________________

City, State, ZIP Code__________________

Phone Number_______________________

Email Address _______________________

Property Address if different than above_____________________

Closing Date_________________________

How did you first hear about ZipRealty, Inc.?_______________________________________________________

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Who was your Agent(s)?_______________________________________________________________________

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What was your expectation when you decided to buy or sell a house through ZipRealty, Inc.?

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Please explain why ZipRealty's service did not meet your expectations.

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Did you have any contact with our customer service personnel? What was your experience like?

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Please describe your experience working with your Agent.

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Did you alert your agent of your dissatisfaction during the process of your purchase or sale?

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Although ZipRealty's service did not meet your expectations, would you use ZipRealty, Inc. as
your real estate agent in the future? Please explain why or why not.

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I affirm that the statements, impressions, and recollections made above are true and accurate to the best of my belief. I represent that I have the authority to seek this Guarantee on behalf of all other co-buyers or co-sellers involved in the transaction described above and that they are aware and consent to my seeking payment under this Guarantee and that no further money will be paid out under this Guarantee for this transaction.