Referral Form

The Ginther Group Referral Form

Thank you for partnering with us.
REFERRING FIRM INFORMATION:
Date*

MonthDayYear
Date
Tell us who you are:*

I am a Ginther Group/Ginther Group Network AgentI am referring to a Ginther Group/GInther Group Network Agent
Type of Referral:*

Referring OutInbound Referral
Is the referral to another Ginther Group Network Agent, either at the Hub or an Expansion Partner?

YesNo
Source of Referral *
Your Market Center*
GG/GGN Agent Name*
If you are an ISA, please use Blake Ginther as the referring agent name
ISA Name
If you are an ISA referring a team lead, please insert your name here
Referring Agent Name*
Referring Agent Phone Number*
Referring Agent Email*
example@example.com
Referring Firm Name*
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:
License Number*
What is the expected referral fee percentage?*
RECEIVING FIRM INFORMATION:
Area the client is moving to/selling in:

Winston-Salem/Triad AreaGreensboro AreaBurlington/Chapel Hill/Central AreaRaleigh/Duham/Triangle AreaRoanoke/Virginia AreaOther
GG/GGN Agent client is being referred to:
Agent you are referring your client to:

First NameLast Name
Receiving Firm Name:*
Receiving Agent Firm Street Address:
Receiving Agent Firm Additional Street Address:
Receiving Agent Firm City:
Receiving Agent Firm State:
Receiving Agent Firm Zip:
Receiving Agent Phone:
Receiving Agent Email
example@example.com
PROSPECT INFORMATION:
Prospect Name*

First NameLast Name
Prospect Address:
Prospect Phone Number

Area CodePhone Number
Prospect Email:
example@example.com
Type of Business Referred*
Is your client aware of this 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 GG/GGN Agent

Clear
Signature of Referring Agent

Clear
Signature of Agent/Broker Receiving Referral

Clear
Blake Email
example@example.com
Alexandra Email
example@example.com
Anthony Email
example@example.com
Candler Email
example@example.com
Daniel Email
example@example.com
David Email
example@example.com
Emily Email
example@example.com
Fatima Email
example@example.com
Frank Email
example@example.com
Jelaina Email
example@example.com
Kathy Email
example@example.com
Cesar Email
example@example.com
Layne Email
example@example.com
Mary Email
example@example.com
Megan Email
example@example.com
Pedro Email
example@example.com
Steven Email
example@example.com
Ty Email
example@example.com
Val Email
example@example.com
Blake Phone
Alexandra Phone
Anthony Phone
Candler Phone
Cesar Phone
Daniel Phone
David Phone
Emily Phone
Fatima Phone
Frank Phone
Jelaina Phone
Kathy Phone
Layne Phone
Mary Phone
Megan Phone
Pedro Phone
Steven Phone
Ty Phone
Val Phone
KWRE Steet Address
KWRE Additional Steet Address
KWRE City
KWRE Zip
KW Chapel Hill
KW Roanoke
KW Greensboro
Keller Williams Realty Elite - Winston-Salem
KW Realty Roanke Street Address
KW Realty Roanoke Additional Street Address
KW Realty United Street Address
KW Realty United Additional Street Address
KW Realty United City
KW Realty Roanoke City
KW One City
KW One Street Address
KW One Additional Street Address
KW One Zip
North Carolina
Virginia
KW Realty United Zip
KW Realty Roanoke Zip
Alexandra
Anthony
Blake
Candler
Cesar
Daniel
David
Emily
Fatima
Frank
Jelaina
Kathy
Layne
Mary
Megan
Pedro
Steven
Ty
Val
Alex License
Anthony License
Blake License
Candler License
Daniel License
Fatima License
Jelaina License
Kathy License
Layne License
Mary License
Megan License
Ty License
Pedro License
Emily License
Frank License
Steven License
Cesar License
Should be Empty:

The Ginther Group Referral Form