OUTGOING
REFERRAL FORM
Relocation
Department: 1884 W.
Stadium Blvd., Ann Arbor, MI 48103
Fax 734.665.9918
Tom Shaft
1514 W. Maumee, Adrian Mi. 49221
Direct: 517.902.4620 - Office: 517.263.4100 - Fax:
517.266.1692 - E-mail: tshaft@surovell.com
Please select:
______Buyer ______Seller
______Renter /
_____Call in _____E-Mail
Referring Agent, Office & Phone: Thomas Shaft / Edward Surovell Realtors-ADR. 517.902.4620
Name:
______________________________________________________________________
Address:
______________________________________________________________________
Home
Phone: ___________________________ Office Phone:
__________________________
Email
__________________________________Cell/Pager:
____________________________
Best time to contact: ‹ Day ‹ Evening
Would
you like a relocation packet sent?
YES____
NO____
School Report? YES____
NO____
You’re
Realtor Preferences: ________________________________________________________________________
Personal
Information/comments: ____________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Children? Y N Ages? _________________ Preferred location? ____________________________
Bedrooms ___ Bathrooms ____ Basement ___ Fireplace ___ Sq Ft __________ Price e____________
Additional Needs/Requirement________________________________________________________________________________
_____________________________________________________________________________________________
Assigned to: ______________
________________________ Date: ____________________
Agent Name:
_____________________________REF %
________ Phone #_____________
Fax: ________________________ Email________________________________