Referring Agent Information

Referral Agent Name *

Referral Agent Phone Number *

Referral Agent License # *

Referral Agent Email Address *

Receiving Brokerage Information

IAMREADI LLC dba READI Real Estate

757-302-1222

739 High St, 109; Portsmouth, VA 23704

[email protected]

Brokerage Licence #: 0226034835

Broker Tax Identification Number: 88-1315479

Customer Information

Client Type *

Client Type

Buyer
Seller
Tenant
Landlord
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List is empty.

First Name *

Contact Number *

Last Name *

Email *

Street Address

City

State

E-Mail Address *

Preferred Location

Price Range

$150,000 - $250,000
$250,000 - $350,000
$350,000 - $700,000
Other
NA
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Is Client Prequalified

Yes
No
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Additional Details

Referral Consent *

Referring agent has obtained permission from customer to refer customer.

Compensation

Receiving brokerage agrees to pay to referring brokerage a % of the referred side of the receiving brokerage’s commission within 10 business days of settlement.

Requested % of Commission *

Provide Broker details below. This form will be emailed to Broker for Signature.

Referring Broker Information

Name of Broker *

Brokerage License number *

Referring Broker - Contact Number *

Referring Broker Email *

A COPY OF THIS FORM SHALL BE SUBMITTED TO EACH AGENT’S MANAGING BROKER FOR SIGNATURE

Payment Details

Payment Preference *

Wire Transfer

Check

Wire Transfer- Upload ACH Letter

Check - Referring Brokerage Mailing Address (Include Attention to Details)

Upload Referring Broker W9

Upload Broker W9

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