Berkshire Hathaway HomeServices Woodmont Realty - Submit Referral or Customer to Relocation

  • Submit a Referral
  • Register an Incoming Customer
This is:  
Member Number:  
*Customer Name:
*Pri First Nm: Sec First Nm:
*Pri Last Nm: Sec Last Nm:
Marital Status
Your Relation to Customer:
Has customer had prior contact with an agent?  
If yes, provide company name and agent name  
*Customer's Mailing Address:  
*Mailing Address City:  
*Mailing Address State:  
*Mailing Address Zip:  
*Mailing Address Country  
*Home Phone:  
Primary Work Phone:
Secondary Work Phone:
Primary Email:
Secondary Email:
Cell (primary):
Cell (secondary):
Best time to call:
Kids? Please describe.
*Confidential Referral?  
*Did you ask customer permission?  
*Type of Referral:      
Add'l Comments:
*Your Name:

Please Select Your Name

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*Your Name:  
*Your Email:  
*Your Phone #:  
*Your Office:  
If placed directly, please include the agent's name, company and contact information.

DO NOT USE this Register Customer Tab when submitting a new Outgoing (B2B) referral or Agent/Self Generated Referral (AGR). This tab is strictly for Registering Customers. Please use the other tab (Submit a Referral) to ensure that your new referral is received by your Relocation Dept.

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.

*First Name:
*Last Name:
Secondary First Name:
Secondary Last Name: (if different)
Member Number:
Home Phone:
Other Phone:
Primary Cell #:
Secondary Cell #:
Primary Work #: x
Secondary Work #: x
Primary Email:
Secondary Email:
*Your Name:

Please select Your Name

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