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

 

DATE _______________________________

 

Please select:   ______Buyer   ______Seller   ______Renter /    _____Call in    _____E-Mail

 

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

YOUR INFORMATION

 

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________________________________