NSBAR Referral Network Agreement

NSBAR Referral Network Agreement
Referring Broker Name*

First NameLast Name
Check Remittance Address

NSBAR Referral Network
450 Skokie Blvd BLDG 1200
Northbrook, IL 60062

Please reference the referring agent name and property address.
Property MLS Number or Property ID Number (PIN)*
Phone Number*
Please enter a valid phone number.
Email*

Confirmation Emailexample@example.com
Illinois Real Estate License Number*
Receiving Brokerage Information
Company*
Managing Broker*
Receiving Broker*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Receiving Broker License Number*
Client Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Notes
Acceptance of Referral
Receiving Office accepts this referral and agrees to NSBAR Referral Network, upon closing of the transaction, the amount of Numeric Only*% of the compensation received by the office as broker for the client referred to us by this Referral Agreement.
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
Signature*

First NameLast Name
Date*

MonthDayYear
NSBAR.org
450 Skokie Blvd, Bldg 1200
Northbrook, IL 60062
Deborah@nsbar.org
Should be Empty: