For Use 6/23 -6/29 Only

COLDWELL BANKER GUNDAKER

OUTGOING REFERRAL FORM

Please use for placing referrals outside of your local service area

Phone: 800-417-6270 Fax: 781-609-1946 Email:

DATE: / NAME: / BRANCH/SALES OFFICE:
OFFICE #: / HOME #: / CELL #:
EMAIL ADDRESS: / Routine contact with you will be via email.
Please have Assigned Agent call me before contacting Customer: / Please just send me Key Updates:
Client NAME: /

Spouse/Partner:

HOME #:

OFFICE #:

CELL #:

Current Address:

Email:

Best time to contact:

/ Morning / Afternoon / Evening /

Employer

I have asked the customer’s permission to refer them. NO REFERRAL PLACED WITHOUT IT!

/ Yes: No:
Listing Referral: / Is this property currently listed? / Yes: No: / With Whom?
ADDRESS: / CITY/STATE: / ZIP:
Home Style (SFH, condo, land, etc): / # Bed Rms: / # Baths:
Buyer Referral:
DESTINATION CITY AND STATE:
Reason for Real Estate Need (2nd home, job transfer, family, etc.):
PRICE RANGE (important): / Type of Housing Desired:
# Bed Rms: / # Baths: / # Garage: / # Children: / Ages:
Date Of Move: / Househunting Date: / School Needs:
Present Home:
Listed: / $ / Sold: / $ / Closing Date: / Rent:

Special Instructions:

**If you have already selected an agent to work with this client, please fill out the information below:

Agent Name: Broker: Office Ph #: Cell#: Email:

***REQUIRED FIELDS ARE IN BOLD PRINT***

Remember the more information we have the better job we can do for you!

Thank you.

Revised 04/13/09