Firm's Name

Address

City, State, Zip

Phone, with area code

Evening Phone, with area code

Referral Fee Requested

Email

  Customer Information

Buyer or Seller?

Name of Referral?

Customer Address

Customer City, State, Zip

Customer Phone, with area code

Customer Fax, if applicable

Customer Email

When is the appropriate time to contact the Customer  

Buyer Questions:

How are you associated with the Customer?

How soon does this Customer plan on buying?

Do they have a home to sell?

If so, who is it listed with?

What is the list price? Is it priced to sell?

At what price range will they be buying?