Broker To Broker Referral Form
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1BROKER TO BROKER REFERRAL FORM
This Contract is Intended to be a Binding Real Estate Contract
Referral Date: _________________________________
O
B
I
RIGINATING
ROKER
NFORMATION
Broker ID #
Date Sent:
Expiration Date:
Name
Referring Sales Person:
Address:
License #
City/ST/Zip
Referral Contact:
Company Phone:
Phone #
Company Fax:
Fax #
Email:
Email:
C
I
BUYER
SELLER
RENTER
USTOMER
NFORMATION
Name 1:
Name 2:
Home #:
Home #:
Work #
Work #:
Email:
Email:
Address:
Address:
City/ST/Zip:
City/ST/Zip:
Company:
Company:
Position:
Position:
Best Time To Contact:
At:
Home:
Work:
Contact Name:
Confidential? Yes
No
D
B
I
:
ESTINATION
ROKER
NFORMATION
Name:
Broker ID:
Address:
Phone #:
Fax:
Email:
The Originating Broker and the Destination Broker agree to:
1.
Abide by all applicable laws, including the Fair Housing Act and to provide service to any person without regard to race, color,
religion, national origin, sex, ancestry, age, marital status, physical or mental handicap, familial status, military status, unfavorable
discharge from military service, sexual orientation, or any other class protected by applicable fair housing laws.
2.
In the event a sale results from this referral within a period of 18 months of origination date, Destination Broker agrees to pay the
Originating Broker at the time of closing.
3.
Destination broker agrees to pay ___% (____) of commission paid for the referral side before the sales professional split.
4.
In the event that Destination Broker cannot satisfy the customer’s needs, Destination Broker will return this referral form to
Originating Broker and will not further refer the customer to another broker without prior consent of Originating Broker.
[RETURNING THE FORM DOES NOT TERMINATE THE AGREEMENT. FURTHER, ACCORDING TO THE ACKNOWLEDGEMENT BELOW,
THE ORIGINATING BROKER WOULD ALREADY HAVE THIS FORM. IS IT THE INTENTION THAT THIS AGREEMENT IS TERMINATED IF
THE DESTINATION BROKER DOES NOT SATISFY CUSTOMER’S NEEDS?]
Referral Acknowledgement – Destination Broker MUST sign and return to Originating Broker:
Authorized Signature: __________________________________ Date: _________________________
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