Irongate Realtors- Referral Submit Form

Irongate Realtors- Register Customer with Relocation

Submit a Referral
Register an Incoming Customer

*This is:

Member Number:

*Customer Name:

VIP?:

Marital Status:

Your Relation to Customer:

Has customer had prior contact with an agent?:

If yes, provide company name, agent name, email and phone #:

*Mailing Address Country:

*Customer's Mailing Address:

*Mailing Address City:

*Mailing Address State / Province:

*Mailing Address Zip / Postal Code:

*Phone Numbers:

Cell (primary):

Cell Country:

Primary Work Phone:

Work Phone Country:

*Primary Email:

Secondary Email:

Best time to call:

Kids? Please describe:

Confidential Referral?:

*Did you ask customer permission?:

*Type of Referral:

*Property Address Country:

Property Address:

Property City:

Property State / Province:

Property Zip / Postal Code:

Currently Listed?:

If yes, Listing Price:

Estimated Sale Price:

Must Sell By:

Type Of Home:

Style:

Sq Ft:

Bedrooms:

Bathrooms:

Lot Size:

Special Features/Improvements:

Special Needs:

Primary Destination (City, State):

Alternate Destination:

*Price Range:

Familiar w/Area?:

Reason for Relocation:

In-home Date:

Trip Date:

Employer:

Start Date:

Secondary Employer:

Pre-qualified?:

If yes, Amount:

First Time Buyer?:

HOUSING REQUIREMENTS

Style/Type Desired:

Bedrooms:

Bathrooms:

Special Needs:

Preferred Agent

Additional Comments:

*Your Name:

Your referral has been submitted to the Relocation Department. If there are any questions, they will contact you directly.

Note: It is very important that you enter as much information as you can, to ensure we can find your customer. Misspelled names, mailing address, or email addresses increase the likelihood we would not be able to find your customer. In addition, for example, if you supply an email address, but not a phone number, and we receive the referral without an email address, but with a phone number, we may not be able to match the customer.

Customer Name:

*First Name:

*Last Name:

Secondary First Name:

Secondary Last Name:

*Employer:

*Service Type:

Mailing Info:

Country:

Address:

City:

State:

Zip:

*Phone Numbers:

Primary Cell #:

Primary Cell Country:

Other Phone:

Other Phone Country:

Secondary Cell #:

Secondary Cell Country:

Primary Work #:

Primary Work Country:

Secondary Work #:

Secondary Work Country:

Email:

Primary Email:

Secondary Email:

*Your Name:

Email a Confirmation to Me

Comments: