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Referral Transmittal Form

"Part A"
Receiving Realtor®

To:	Firm:
Address:	Additional:
City:	State:
Zip code:	Work Phone:
Home Phone:	Fax:

Referring Realtor

From:	Firm:
Address:	Additional:
City:	State:
Zip code:	Work Phone:
Cell Phone:	Fax:
E-Mail:

Current Housing Information

Status:	Sold	Pending	Active	Renting
Amount of cash available for Purchase:
Must Home be Sold First?		Yes	No
Reason for Move:		New Job	Transfer	Other
Expected Date of Arrival:
Moving Date:

Client Information (to be provided upon acceptance)

Name:	Address:
Additional Address:	City:
State:	Zip Code:
Work Phone:	Home Phone:
Fax:	Number In Family:
Adults:	Children:
New Employer:	Position:

Desired Housing Information

Preferred Location:
Price Range:
Type of Property: Commercial Condominium Land Multi-Family Single Family Townhouse Other:
Number of Bedrooms:	Number of Baths:
Garage: (Example 2Car/Att)	Schools:Public - Private

Comments:

Acknowledgement of Referral

We accept this referral, and in the event of a sale, agree to send % of the
Listing, Selling, commission. We will enclose Details of the sale with a check to the "Referring "Realtor" in care of the Brokerage Firm.

 

Please contact me as soon as possible regarding this matter.

Note: By Submitting this form, the Sender agrees to the referral terms as stated above.