KELLER WILLIAMS REFERRAL FORM
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SECTION 1 - SENDING OFFICE
Federal Tax ID #
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RECEIVING OFFICE
Federal Tax ID #20--5655754
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Agent:
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Agent: Larry Maida
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Firm Name:
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Firm Name: Keller Williams Realty (MarketCenter #712)
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Address:
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Address: 1709 Laskin Road
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City/State/Zip:
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City/State/Zip: Virginia BeachVA23454
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Business Phone:
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Business Phone: (757) 321-7595
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Cell Phone:
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Fax Phone: (757) 422-4624
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Fax Phone:
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Agent Phone: (757)4072812
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SECTION 2 - SELLER INFORMATION
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Seller Name:
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When to make initial contact:
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Address:
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Property address to be listed:
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City/State/Zip:
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Business Phone:
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Home Phone:
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Additional Helpful Information:
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Fax Phone:
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SECTION 3 - BUYER INFORMATION
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Buyer's Name:
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New Employer:
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Address:
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Address:
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City/State/Zip:
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City/State/Zip:
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Business Phone:
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Position and Approximate Salary:
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Home Phone:
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Must home be sold first?
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Fax Phone:
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Company buyout?
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Preferred Location:
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Cash Available for Purchase and Closing Costs:
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Size and Type of Home Desired:
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Contact Buyer at this no. first:
By this date:
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PriceRange: $
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Expected Arrival Date: Moving Date:
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Number in Family:
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Comments:
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Adults:
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Children: Age:
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Age:
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Age:
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SECTION 4 - REALTOR'S ACCEPTANCE OF REFERRAL
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Prospect's Name:
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Comment:
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Date Contacted:
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Date of First Appointment:
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WE ACCEPT THIS REFERRAL, AND WHEN THE SALE IS CONSUMMATED, WE AGREE TO SEND _25__%. (OF THE GROSS COMMISSION) REFERRAL FEE. WE WILL ENCLOSE A COPY OF THE SETTLEMENT STATEMENT WITH THE CHECK.
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Receiving Sales Associate Signature: Date: / /
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Receiving Broker's Signature: Date: / /
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