Re/max Referral Form

Sending Agent Information

Agent Name: Jean Seguin

ID: V62653

Receiving Agent Information

Agent Name:

ID:

Client Information

Name:

Address:

Email:

City:

Phone Number:

Is the Number correct? YesNo

Did you set up MLS Search? YesNo

Working with Realtor? YesNo

Comments:

Referral Agreement Details

By checking "I Agree" below, the receiving agent: agrees to have his/her broker-in-charge pay an agreed upon referral fee of : % to the sending agent's broker-in-charge, for the Benefit of the sending agent, Jean Seguin.

Based on: Listing Sideor Selling Side