This is an older version of our referral form:
Please fill out the updated form here: https://form.jotform.com/221924749257162
Referral Contact Information
REFERRING FIRM INFORMATION:
Referring Agent Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Are you an Agent with the Ginther Group or Ginther Group Network?
*
Yes, Ginther Group or Ginther Group Network Agent
No, but I am a Keller Williams Realty Elite Agent
No, but I am a Keller Williams Burlington Agent
No, but I am a Keller Williams Greensboro Agent
No, not affiliated with any of these firms
Other
Source of Business
*
Team Lead, SOI, Past Client
License#:
*
Referring Agent Phone Number
*
-
Area Code
Phone Number
Referring Agent Email
*
example@example.com
Referring Firm Name
*
Referring Firm#:
*
Referring Firm Street Address:
*
Referring Firm Additional Street Address:
If on a team, please insert team name here
Referring Firm City:
*
Referring Firm State:
*
Referring Firm Zip:
*
Are you in agreement to a 25% referral fee?
*
Yes or No
What is your expectation of a referral fee percentage?
RECEIVING FIRM INFORMATION:
Receiving Firm Name:
*
Receiving Firm #:
Receiving Agent Firm Address:
*
Do you have an Agent in Mind for this referral?
First Name
Last Name
Receiving Agent License #:
Receiving Agent Phone:
*
Receiving Agent Email
*
example@example.com
PROSPECT INFORMATION:
Prospect Name
First Name
Last Name
Prospect Address:
Prospect Phone Number
-
Area Code
Phone Number
Prospect Email:
example@example.com
Type of Business Referred:
*
Options: Buyer, Seller, Dual, Commercial, Renter
Is the Prospect aware of the Referral?
*
When will you be notifying your client of the referral?
Tell us about your client and what they are looking for:
Signature of Referring Agent
Submit
Should be Empty: