Prairie State Referral Network Agreement

Prairie State Referral Network Agreement

Agent to Agent Agreement
Check Remittance Address

Prairie State Referral Network
450 Skokie Blvd. Bldg. 1200
Northbrook, IL 60062

Please reference the referring agent name and property address.
Referring Agent Name*

First NameLast Name
Referring Agent Phone Number*
Please enter a valid phone number.
Referring Agent Email*

Confirmation Emailexample@example.com
Listing or Buyer Brokerage Information
Listing or Buyer Agent*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Purchase/Sold Property Address
Address*
City*
State*
Zip Code*
Notes
Acceptance of Referral
Receiving Office accepts this referral and agrees to Prairie State 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.
Listing or Buyer Agent Signature*

First NameLast Name
Listing or Buyer Agent Managing Broker*
Referring Agent Signature*

First NameLast Name
Referring Agent Managing Broker
Date*

MonthDayYear
Prairie State Referral Network
450 Skokie Blvd, Bldg 1200
Northbrook, IL 60062
Deborah@prairiestatereferralnetwork.com
Should be Empty: