Referral Source, LLC
1501 Bass Road
Macon, Georgia 31210
Tax ID# 33-1023336
Print Name of Customer _________________________________________________
Signature of Customer ____________________________________________________
Important: The customer must give permission to be referred.
Referred party knows they are being referred and a monetary value of 70% of a 30%
referral fee be received by referring agent upon closing of said transaction? This in no
way will affect monetarily the customer…only the referred agent. Yes ___ No___
In consideration of this referral, it is understood and agreed between the undersigned
parties that upon closing of the above referred customer, a fee of 30% of the commission
earned on the referred side of the transaction will be paid to Referral Source, LLC, 1501
Bass Road, Macon, Georgia 31210.
Referring Broker Receiving Broker
Referring Agent Assigned Agent