E-Referral Form

Please provide the following information so I can assist you with your real estate needs. Within a few days after submission of this request form, you will be contacted for assistance with your needs. If you are not contacted, give me a call at (616) 682-0678. Always eager to help!

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E-Real Estate Assistance - Buy/Sell

		Your first name:
		Your last name:
		Spouse/Other first name:
		Spouse/Other last name:
		Home address:
		City:
		State:
		Zip:
		Phone:
		Additional phone:
		Best time for agent contact:
		Are you interested in listing a currently owned property?
		If not the address above, please complete:
		City:
		State
		Zip
		Type of Property (house, condo, vacation, etc.)
		Price range (from) $
		Price range (to) $
		Specific needs (# of bedrooms, baths, room sizes, etc.)
		Desired location (city and state)
		Broker or agent preference?
		Why do you want to work with them?
		Have you already been in contact with this firm?
		If we need to reach you, a daytime phone?
		Email address
		Any other helpful information