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Agent Intake Form
Full Name
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Email address
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Phone number
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Brokerage Name
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License Number (Optional)
What type of realtor are you?
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Individual Agent
Broker (Company)
What is your experience level in real estate?
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New Agent
Experienced Agent
Veteran Agent
Broker
What do you specialize in?
Please select at least one option.
Residential - Condominiums
Residential - Homes
Commercial Properties
Agricultural Properties
First-Time Buyers
Which areas do you serve?
What services are you interested in?
Please select at least one option.
Silver Package
Gold Package
Platinum Package
Your preferred lead type
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Buyers
Sellers
Renters
Investors
Are you open to paying a referral fee?
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Yes
No
Additional questions or comments
How did you hear about us?
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