Referral - REALTOR®

You have our assurance that your referral will be handled with the utmost care. We are client oriented and have a wealth of experience in our market area. You will be kept informed of your referral’s progress on a regular basis by e-mail and be paid a 25% referral fee on either the Buying or Selling side the same day commissions are received.


	Broker/Agency Information: (items in red are required)
	First Name
	Middle Initial
	Last Name
	Business Name
	Address
	Suite
	City/Town
	State
	Zip Code
	Agent Telephone
	E-mail Address
	E-mail Address (enter again to verify)
	SS# or Federal Tax ID#
	Referral Information: (items in red are required)
	First Name
	Middle Initial
	Last Name
	Business Name
	Street Address
	Suite
	City
	State
	Zip Code
	Telephone #1
	Telephone #2
	Telephone #3
	E-mail Address
	E-mail Address (enter again to verify)
	Contact Instructions
	Anticipated Move Date
	Price Range
	Financing Required
	Current Residence Listed?	Yes No
	Must Sell Prior to Moving?	Yes No
	Needs & Wants
	Special Needs
	Comments