NATIONAL REFERRAL FORM

Relocation Department:  1884 W. Stadium Blvd., Ann Arbor, MI  48103 

   Tom Shaft

Direct: 517.902.4620  -  Fax: 517.266.1692  -  E-mail: tshaft@surovell.com

 

DATE __________________     (Circle):    Outgoing     Incoming     Both     Not Sure?

 

Please select:   ______Buyer    ______Seller    ______Renter    ______Call in    ______E-Mail    ______Other

 

Referring Agent, Office & Phone: Thomas Shaft / Edward Surovell Realtors-ADR: 517.902.4620

YOUR INFORMATION

 

Name: _____________________________________ Company:___________________________

 

Addresses: _____________________________________________________________________

 

Home Phone: _____________________________  Office Phone: __________________________

 

Email ____________________________________  Cell/Pager: ____________________________

  

Best time to contact:   ‹ Day    ‹ Evening     ‹Other:________________________

 

Would you like a relocation packet sent?     YES____     NO____     School Report?   YES____    NO____

 

You’re Realtor Preferences: ______________________________________________________________________________

 

Personal Information/comments:  ________________________________________________________________________________

 

_____________________________________________________________________________________________________________________

 

_____________________________________________________________________________________________________________________

 

_____________________________________________________________________________________________________________________

 

_____________________________________________________________________________________________________________________

 

_____________________________________________________________________________________________________________________

 

_____________________________________________________________________________________________________________________

 USE ADDITIONAL BLANK SHEETS IF NEEDED  -  REMEMBER TO SEND / FAX ALL SHEETS

Children?   Y    N   Ages? _________________   Preferred location? ___________________________________________

 

Bedrooms ____   Bathrooms ____   Basement ____  Garage ____  Fireplace ____   Sq Ft ________  Price____________

 

Additional Needs / Requirements / Approvals / Contacts:________________________________________________________

 

_____________________________________________________________________________________________________________________

 

_____________________________________________________________________________________________________________________

 TO BE COMPLETED BY REFERRAL COMPANY

Assigned to:  ______________ ________________________ Date: ____________________

 

Agent Name: _____________________________REF %   ________ Phone #________________________

 

Fax: ________________________            Email________________________________________________

QUESTIONS?   CALL TOM SHAFT DIRECT:  517.902.4620  OR  FAX:  517.266.1692