Assisted Living Agent Partners

1
Your Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Please enter a valid phone number.
4
Date
Date
Year
Month
Day
5
Where Are You Located?* This field is required.Pick the center of your service area if possible. Areas you serve is the next question!
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
Cities/Areas You ServeList the most common cities/areas you typically service. This will help us better match you to buyers & sellers.
7
Have you ever sold a RESIDENTIAL Assisted Living Home, whether currently operating listing or purchasing for a buyer who intends to use as assisted living?* This field is required.
YESNO
8
**Watch this 3 Minute Video!**
9
Do you currently or frequently have assisted living homes to sell?* This field is required.
YESNO
10
Are you able to or have someone who can prepare commercial leases for residential assisted living?* This field is required.
YESNO
11
Do you have the ability to source and vet assisted living business operators/owners/tenants?* This field is required.
YESNO
12
Our buyers are counting on YOU to be the expert on what homes could BECOME or continue to be licensed residential assisted living homes. Are you willing to do some initial research on assisted living home regulations for each of the cities you listed and any areas you'd like to serve our buyer community for? We will ask you to submit some cursory research on locality home requirements, government office responsible for regulations, that website, and contact info.* This field is required.
YESNO
13
We appreciate your partnership and plan to send as much business your way as possible from our network and community. Do you agree that for all business that comes from our 3 Facebook communities ("Residential Assisted Living", "Assisted Living Facilities", & "Assisted Living Buy Sell) by any means or directly from Charles Cameron (a licensed real estate professional), to pay a 25-30% commission referral fee for the sale, purchase, or lease (any/all) of an assisted living property for that client?* This field is required.
YESNO
14
Brokerage Name* This field is required.Include "LLC" or any other business suffix.
15
Broker Name (for signing referral agreements)
16
Broker Email (for signing referral agreements)
example@example.com
17
Save Time Later by Uploaded a Current Brokerage Tax Form W-9
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18
Referral Partner Agreement - Please Review
19
Referral Partner Agreement — Sign to Join* This field is required.By signing below, I agree to the Buy Sell Assisted Living Referral Partner Agreement: a total referral fee not to exceed 30% per referred client; I will contact each referred client by phone within 24 hours and remain responsive throughout; this covers buyers of existing RAL homes, residential properties to convert, or land to develop, and RAL sellers; for a 2-year term. The full agreement will be provided for your records.
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