The Rescue Agents - Referral Signup
Use this form to become a referral agent in your area.
Name
*
First Name
Last Name
Email
*
example@example.com
Company Name/Brokerage
*
Company/Brokerage Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company/Brokerage Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you a broker or an agent?
*
Please Select
Broker
Agent
What state(s) are you licensed in?
*
Real Estate License Number
*
Digital copy of real estate license (if available):
Browse Files
Drag and drop files here
Choose a file
Cancel
of
What MLS Systems do you work in?
*
By agreeing to become a "Rescue Agent", you will be sigining a referral agreement with our Brokerage (we are a multi-state licensed brokerage) of 20% of the commission.
Our commissions will be placed on the HUD and paid by the title company (unless your brokerage requires them to distribute the commissions after close - please let us know)
The agreement will be for 1 year after we provide the lead.
Do you agree to the terms above?
*
Yes
No
Signature
*
Submit
Should be Empty: