Your Name:        

Email:

Are you an Agent or Loan Officer?:     R.E.       L.O.

Type of Referral:      Buyer Seller  Buyer & Seller   Financing   Refi

Client Name:      

Have you made contact with the client?:  Yes   No

General Status of Referral:

Please Choose: Active Buyer/Seller (motivated) Future meeting with customer set up Under contract with referral customer buying/selling in 6+ months Unable to contact referral customer Invalid contact information for referral customer Not a serious buyer/seller Unable to secure financing Customer already working with agent

Rate the possibility of this referral coming to a successful closing:

(1=very unlikely)  1   2   3   4   5    (5=very likely)

Has any of your contact info changed recently?  (email, fax, etc.)