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THE BASICS

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					                                 Referral Form
THE BASICS                                                         Date : ____________

The Client will be a:   ___ Seller     ___ Buyer

ABOUT THE CLIENT

Client Name(s): _________________________________________
Email Address: _________________________________________
Mailing Address: ________________________________________
City, State, Zip : ________________________________________

Phone numbers (including area code):
Day: ______________________ Evening: _________________
Fax Number:__________________

The client’s reason for a change is: ____________________________
Date by which your client plans to move : ______________________
Is he/she being relocated by an employer?          ___ Yes     ___ No
   If yes, will the employer pay the relo expense? ___ Yes     ___ No


FINANCING

Has he/she been pre-qualified by a lender? ___ Yes ___ No
       If yes, what is the loan amount? __________________

Will part of his/her purchase funds be coming from the sale of another property?
___ Yes ___ No
If yes, what stage is that sale at? _________________________

HOME INFORMATION:

Approximate Price Range : ______________________________
Minimum Bedrooms ___ 2 ___ 3 ___ 4 ___ 5+
Minimum Baths: ___ 1 ___ 2 ___ 3 ___ 4+
Approximate Square Footage ______________________ sqft
Approximate Age of Home ___ < 5, ___ < 10, ___<20
Home Style : ___ one story ___ Two stories
Parking : ___________________
Amenities: ___ Fireplace       ___Jetted tub in main bath
           ___ Outdoor spa ___ Pool                  ___ Home office
           ___ Waterfront      ___ Cul-de-sac        ___ Block structure
           ___ Golf            ___ Other
       If “other,” describe: ___________________________

Lot, land size (approximate): ___ City Lot (5,000-6,000 sq. ft.) ___ 6,000-10,000 sq.ft.
        ___ ¼ to ½ acre       ___ 1 to 2 acres      ___ 3 to 5 acres     ___Not a Clue
Are there any special facilities?
       ___ Wheelchair access              ___ Lowered counters       ___ Grab Bars
       ___ Other _________________

Other pertinent information:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________


CLIENT’S PREFERRED METHOD TO RECEIVE SEARCH DATA
___ Phone  ___ Fax  ___ e-mail ___ Postal Service



ABOUT YOU (Referring Agent)

Your Name(s) : ________________________________________
Brokerage Name : _____________________________________

Your state licensing designation : ___ Broker ___ Salesperson

E-mail Address : ______________________________________
Mailing Address: ______________________________________
City, State, Zip : ______________________________________
Phone numbers (including area code):
Day : __________________________        Evening: ____________________________

Fax : __________________________          Cellular : ___________________________



YOUR PREFERRED METHOD(s) TO RECEIVE UPDATES

___ Phone     ___Fax     ___ E-Mail    ___ Postal Services




___________________________________              ______________________________
Clients signature                                Referring Broker’s signature


___________________________________              ______________________________
Clients signature                                Referring Broker’s signature


Please Fax to : (407)-363-5311           Or E-Mail to : gliao@AAPacificPartners.com

				
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