REALTORS® REFERRAL FORM * Required Field Client Information * My client is a: Please Select Buyer Seller Seller & Buyer Commercial Buyer Commercial Seller Client Name: * E-mail: Address: City: Province/State: Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Ontario Prince Edward Island Saskatchewan Yukon Northwest Territories --------------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennesse Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming --------------- Other State/Province Postal/Zip: Country: Canada USA Abu Dhabi Aden Afghanistan Albania Algeria American Samoa Andorra Angola Antarctica Antigua Argentina Aruba Australia Austria Bahamas Bahrain Bangladesh Barbados Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Botswana Bouvet Island Brazil British Antarctica Territory British Indian Ocean Territory British West Indies Brunei Bulgaria Burundi Cambodia Cameroon Canada Canal Zone Canary Islands Canton And Enderbury Islands Cape Verdi Islands Cayman Islands Central African Republic Cevlon Chad Chan. 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Don't Know Ask the Client View Notes Year: Employer Relocation: Yes No Name of Employer: Financing Prequalified: Yes No Lender Name: Select Lender Alberta Treasury Branches Bank Of Montreal Bank Of Nova Scotia Canada Trust Canadian Mortgage Centres Canadian Western Bank Capital City Savings C.I.B.C. Hongkong Bank of Canada Laurentain Bank of Canada National Bank of Canada Royal Bank of Canada Toronto Dominion Bank Other Other: Amount: Home needed to buy or sell Select Price Range See Notes Up to $100,000 $100,000 - $110,000 $110,000 - $120,000 $120,000 - $130,000 $130,000 - $140,000 $140,000 - $150,000 $150,000 - $160,000 $160,000 - $170,000 $170,000 - $180,000 $180,000 - $190,000 Up to $200,000 $200,000 - $250,000 $250,000 - $300,000 Up to $300,000 $300,000 - $350,000 $350,000 - $400,000 Up to $400,000 $400,000 - $450,000 $450,000 - $500,000 Over $500,000 _____________________ Style of Home Bungalow Semi-Bungalow Bi-Level 2 Storey Split 3 Level Split 4 Level Split 5 Level Split 2 Storey 2 1/2 Storey 3 Storey ______________________ Select Baths See Notes 1 Bath 1 1/2 Bathrooms 2 Bathrooms 2 1/2 Bathrooms 3 Bathrooms 4 Bathrooms 5 or more baths ______________________ Select Bedrooms See Notes 1 Bedroom 2 Bedroom 3 Bedroom 4 Bedroom 5+ Bedroom _____________________ Select Age See Notes New Up to 5 Years Up to 40 years Not a concern ______________________ Select Size See Notes Up to 1000 sq. ft. 1000 - 1500 sq. ft. 1500 - 2000 sq. ft. 2000 - 2500 sq. ft. 2500 - 3000 sq. ft. 3000 - 3500 sq. ft. Over 3500 sq. ft. _____________________ Select Parking See Notes Carport OK Single garage attached Single garage detached Double garage attached Double garage detached Triple garage attached Tripe garage detached Not a concern ______________________ Type of Home Single Family Detached Single Family Attached Duplex Half Duplex Triplex Low-Rise Apartment Hi-Rise Apartment Townhouse Carriage Quadplex Vacant Lot _____________________ Additional Notes: Client's preferred method to receive updates Phone Fax Email Postal Service Agent Information Sales Rep Name: Agency Name: Agency branch or location: E-mail Address: Mailing Address: City: Telephone: Pager: Fax: Cellular: Agent's preferred method to receive updates Phone Fax Email Postal Service Please enter the seven letters that appear above in the following input box: Get New Code Text is entered in upper case automatically Real Estate Services | Value Of My Home | REALTORS® Apply Now! Alberta REALTORS®

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