Client Registration Form as Buyer's Agent

Client Registration Form as Buyer's Agent
At The Rollins Group LA, we makes it quick and easy to register your clients, so it protects your relationship. We will need to qualify your Buyer/Client prior to releasing any information. We can work together to make this qualification process quick and easy!

Please use the TEXT BOX at the end of the form to briefly describe the financial qualifications of your buyer for our review.
Today's Date

MonthDayYear
Date
Property
Client's Name(s)*
Real Estate Agent Name*
Agency*
Principal Broker*
Agency Address*
City*
State*
Zip*
Agent Phone Number
Format: (000) 000-0000.
Mobile Number*
Format: (000) 000-0000.
E-Mail*
example@example.com
Signature-Buyer's Agent

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Date

MonthDayYear
Date
Signature-Client

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Date

MonthDayYear
Date
Signature The Rollins Group LA

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Date

MonthDayYear
Date
Associate State
Associate Zip
1. Commissions earned in the amount of ____% TBD, the net Base price of property only after applying any concessions, discounts, credits or the like including the value of any option, closing cost, financing, or other discount offered in any fashion with regard to this transaction. Will be funded to the above Real Estate Company by TRGLA after closing of the sale to the above-named client provided the client purchases during the registration period.

2. The undersigned acknowledges that in the event the above-referenced purchase fails to close for any reason whatsoever, no commission is earned, nor will a commission be paid by TRGLA.

3. Registration cannot be honored if the Buyers is in any way registered in the leads database by TRGLA prior to this registration. We cannot honor "drive-by" agency. Realtors/ Brokers must register the prospect/customer on the initial form to TRGLA and have an executed agreement by both parties.

4. Realtors/Brokers registered on this form will be protected for a period of 120 days from the date of registration. TRGLA may grant extensions upon written request, any such extension shall be in writing or they are invalid.

5. The expiration of an initial registration without an extension expressly authorizes TRGLA the right to work with the same client without any obligation to the below signed realtor/broker named on this registration form.

6. The Realtor/Broker acknowledges that he has informed the undersigned client and TRGLA that he is acting as a:
Transaction BrokerSeller's AgentBuyer's AgentOther
Client Qualifications*
Should be Empty: