Mandatory fields marked *

Client Information

Type of Client: *

Client's Name:*

Client's Email:*

Client's Phone Number: *

Best time to Call:

Client's Fax Number:

Contact My Client By:

Do Not Call Registry / Referral Awareness

VERY IMPORTANT: Although you should always notify a client of a pending referral, if your client is a member of a do-not-call registry and you have selected "Phone" contact above, you are taking responsibility for the initial phone call made from this organization to your client. If you are not sure of your clients do-not-call status, please select "Email" contact above.

On Do-Not-Call Registry: *

Aware of This Referral: *

Relocation Information

Approximate Time Frame:

Employer Relocation:

Name of Employer:

Financial Information (Buyers)

Pre-Qualified:

Lender Name:

Other Lender:

Pre-Qualified Amount:

Client Real Estate Interest: (Buyers)

Property Type:

City:

Preferred Location(s):

Price Range:

Client Property Looking to Sell: (Sellers)

Street Address:

City:

Province / State:

Country:

Residential Property Needed to Buy or Sell:

Note: if your client is a Buyer, select the criteria they require. If the client is a seller, select the features of the home they wish to sell. In the case that your client is a Buyer & Seller, select the criteria they require for Buying only.

House Type:

House Style:

Living Space:

Building Age:

Bedrooms:

Bathrooms:

Basement:

Garage:

Referrer Information

Your Name:*

Your Email:*

Your Agency:

Your Branch / Location:

Your Phone Number: *

Best time to Call:

Your Fax Number:

Contact Me By:

Request Follow Up: *

Additional Comments

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