Coldwell Banker Upchurch Realty - Submit Referral or Customer to Relocation

Submit a Referral
Register an Incoming Customer

*This is:

Member Number:

*Customer Name:

VIP?:

Marital Status:

Your Relation to Customer:

Has customer had prior contact with an agent?:

If yes, provide company name, agent name, email and phone #:

*Mailing Address Country:

*Customer's Mailing Address:

*Mailing Address City:

*Mailing Address State / Province:

Mailing Address Zip / Postal Code:

*Phone Numbers:

Cell (primary):

Cell Country:

Cell (secondary):

Cell (secondary) Country:

Home Phone:

Home Phone Country:

Primary Work Phone:

Work Phone Country:

Secondary Work Phone:

Secondary Work Phone Country:

*Primary Email:

Secondary Email:

Best time to call:

Kids? Please describe:

Confidential Referral?:

Did you ask customer permission?:

*Type of Referral:

*Property Address Country:

Property Address:

Property City:

Property State / Province:

Property Zip / Postal Code:

Currently Listed?:

If yes, Listing Price:

Estimated Sale Price:

Must Sell By:

Type Of Home:

Style:

Sq Ft:

Bedrooms:

Bathrooms:

Lot Size:

Special Features/Improvements:

Special Needs:

Primary Destination (City, State):

Alternate Destination:

*Price Range:

Familiar w/Area?:

Reason for Relocation:

In-home Date:

Trip Date:

Employer:

Start Date:

Secondary Employer:

Pre-qualified?:

If yes, Amount:

First Time Buyer?:

HOUSING REQUIREMENTS

Style/Type Desired:

Bedrooms:

Bathrooms:

Special Needs:

Additional Comments:

*Your Name:

DO NOT USE this Register Customer Tab when submitting a new Outgoing (B2B) referral or Agent/Self Generated Referral (AGR). This tab is strictly for Registering Customers. Please use the other tab (Submit a Referral) to ensure that your new referral is received by your Relocation Dept.

Note: It is very important that you enter as much information as you can, to ensure we can find your customer. Misspelled names, mailing address, or email addresses increase the likelihood we would not be able to find your customer. In addition, for example, if you supply an email address, but not a phone number, and we receive the referral without an email address, but with a phone number, we may not be able to match the customer.

Customer Name:

*First Name:

*Last Name:

Secondary First Name:

Secondary Last Name:

*Employer:

Member Number:

Service Type:

Mailing Info:

Country:

Address:

City:

State:

Zip:

*Phone Numbers:

Primary Cell #:

Primary Cell Country:

Home Phone:

Home Phone Country:

Other Phone:

Other Phone Country:

Secondary Cell #:

Secondary Cell Country:

Primary Work #:

Primary Work Country:

Secondary Work #:

Secondary Work Country:

Email:

Primary Email:

Secondary Email:

*Your Name:

Email a Confirmation to Me

Comments: