special services

Referral Form

It is understood and agreed that the referring office shall receive a referral fee from the commission earned, on the referral side, from the receiving office should the below mentioned client (Party's Name) buy or sell a property through the receiving office. Please send a copy of the final HUD and all referral commissions to:
Prudential Northern Arizona Real Estate, 723 East Gurley Street, Prescott, AZ 86301
Phone: 928-778-3400 Fax: 1-866-860-7901

Please complete as appropriate:

*Required Fields

Referring Company Referring Tax No. - EIN Referring Address Referring Phone Referring Email
Receiving Company Receiving Address Receiving Phone Receiving Email
*Client Name Client Address *Client Phone Client Email (1) Choose an agent from the dropdowns below.
or
(2) If the agent is not listed there, type the name in the the box below and
type the "Receiving Email" above. Referring Agent Receiving Agent

Referring Agent

Receiving agent:

Referral Type Listing Selling Other (specify below)

Referral Percentage(%)

Additional Information:

We are always looking for good Real Estate Agents to join out team. Go to our careers section for details.


	Property Watch