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BUYER/SELLER/REFERRAL REGISTRATION FORM
Please complete form below if you would like to be matched with a Broker/Agent who has successfully completed our Screening Process and who will, based on your Property Data, Location and Type be handpicked for you.
*REQUIRED information
* Are You using a LandWise Referral Network,LLC Referral Agent? Yes No
* Street Address * City * State * Zip * Daytime Phone Number * Alternate Phone Number * Fax Number * E-Mail Address * Date of Birth
Number of People in Your Family
* Are you a real estate agent? Yes No* Are you presently under contract with a real estate agent? Yes NoPrimary Language Annual Household Income Highest Level of Education
Would you prefer to work with a particular agency or franchise? Yes NoIf yes, what agency or franchise?
Do you prefer a male or female agent? Male Female No preference
BUYER INFORMATION:When do you plan to purchase? Now Within 1 year 2 years + Unsure
Are you a first time buyer? Yes NoAre you prequalified for a mortgage loan? Yes No
Purchase Price Range Less than $100,000 $101,000 to $200,000 $201,000 to $300,000 $301,000 to $500,000 $501,000 to $999,999 $1,000,000+
State of Interest Counties of Interest Zip Codes of Interest
Type of Property Single family residence Condo Townhouse Apartments Vacation home Mobile home Commercial Acreage Farm Other
Comments
SELLER INFORMATION
Street Address of Selling Property City of Selling Property Zip Code of Selling Property Name of Tract or Neighborhood
When do you plan to sell? Now Within 1 year 1 to 2 years 2+ years Unsure
Asking Price Range
By submitting this form you are confirming that you have read, understand and agree with LandWise Terms and Conditions.
Form BSRR 0403-01
