Form
Please note: this form is invalid if not signed by broker, James Krueger. As an agent, you can not execute this form without broker approval.
YOUR Email Address
example@example.com
Referring Broker (This is the person SENDING the referral.)
*
First Name
Last Name
Referring Agent (If Any)
First Name
Last Name
Referring Broker Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Referring Broker Phone Number
-
Area Code
Phone Number
Referring Broker Email
example@example.com
Receiving Broker (This is the person RECEIVING the referral.)
*
First Name
Last Name
Receiving Agent (If Any)
First Name
Last Name
Receiving Broker Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Receiving Broker Phone Number
-
Area Code
Phone Number
Receiving Broker Email
example@example.com
Client Name(s)
*
Referral % Amount
*
25% is Industry Standard - If referral is not a %, pls contact office for help.
Referral Time Period
*
Suggested 12 or 24 Months
Applicable if client...
*
BUYS
SELLS
LEASES
Submit
Should be Empty: