Referral Form
Please fill out thoroughly and accurately.
Sending Office Name
Sending Agent Name
Sending Brokerage Name
Sending Brokerage City/State
Sending Office Phone
-
Area Code
Phone Number
Sending Agent Cell Phone
-
Area Code
Phone Number
Sending Agent Email
example@example.com
Sending Office Tax ID
Make Check Payable to
Receiving Office Name
Receiving Agent Name
Receiving Brokerage Name
Receiving Brokerage City/State
Receiving Office Phone Number
-
Area Code
Phone Number
Receiving Agent Cell Number
-
Area Code
Phone Number
Receiving Agent Email
example@example.com
Referral Client Information
Is the referral for a Buyer or Seller?
Buyer
Seller
Seller Name(s)
Seller Phone Number
-
Area Code
Phone Number
Seller Email(s)
example@example.com
Reason for Moving
Expected Launch Date
/
Month
/
Day
Year
Date
Property Address
City/State
Number of Beds
Number of Baths
Square Footage
Year Built
Lot Size
Buyer Name(s)
Buyer Phone Number
-
Area Code
Phone Number
Buyer Email(s)
example@example.com
Reason for Moving
Expected Move Date
/
Month
/
Day
Year
Date
Date of Next Home Finding Trip
/
Month
/
Day
Year
Date
Price Range
Have they been prequalified (yes or no)
Lender Name
Lender Phone
-
Area Code
Phone Number
Lender Email
example@example.com
Requested # of Beds
Requested # of Baths
Requested Square Footage
Is client familiar with area?
Any additional requirements?
Agreed on Referral Fee?
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