Real Estate Referral Form

You do not qualify for this program if you want to buy a house and are already working with an agent that you want to keep working with, are bound by a buyer agency agreement, or already have a house under contract. If you want to sell a house, you do not qualify if your house is already listed or if you only want to be referred to an agent you've already had contact with.

* denotes required information. The rest is optional. Read our privacy statement.

Salutation *:	Mr. Ms. Mrs. Dr.
First name *:
Last name *:
Middle initial:
Home phone *:
Work phone *:
E-mail *:
Address, line 1 *
Address, line 2
City *:
State *:
Zip/Postal Code *:

If you want to sell AND buy, complete both columns below:

If you want to buy, complete this column:

When would you like to be in your new home? *

Do you need help selling your current home?:
If so, please complete the right half of this form as well.

Is your current home already listed with a broker?
Yes No Renting

Would you like to be pre-approved for a home loan at no cost? Yes No

In what city do you plan to buy?

State?

Area of city, if you know:

How far are you willing to drive to your place of employment?:

Where is your employer located (address)?:

Are you relocating? yes no

If so, when do you plan on being in your new city to look for homes?

Have you signed a buyer agency agreement with a broker that is still in effect? Yes No

If so, when does it expire?

Name of agent and company:

Price range (Example $120,000-$150,000):

Our Mortgage Calculator will tell you the mortgage payments for any house price you choose.

Type:

# bedrooms: # bathrooms:

Lot size:	Basement:
Stories:	Age:

If you want to sell, complete this column:

How quickly do you need to sell? *

Address of property:

City: State:

Area of city:

Estimated market value

Would you like to:

Have you tried to sell the property on your own?
yes no

Is the property currently listed with a broker?
yes no

If so, when does the listing expire?

Name of agent and company::

Type:

# bedrooms: # bathrooms:

Lot size:	Basement:
Stories:	Age:

If you would prefer to be referred to a certain real estate office in particular, please enter the name of that office
Name of agent, if you have a preference
Have you already had contact with that agent?	yes no
Telephone number of that office

Other comments or instructions:

Please make sure you have entered the correct contact information before you click on the Submit button. We cannot refer you to an agent if we can't get a hold of you.

Let us know about your needs and objectives by filling out this form. The information you provide will help us choose the right agent for you.

Let us know about your needs and objectives by filling out this form.
The information you provide will help us choose the right agent for you.