PROSPECT REFERRAL FORM - Dempsey Auction



The Jeanne L. Witt Estate —January 21, 2021

_____________________________________________________________, a real estate brokerage firm licensed by the Georgia Real Estate Commission, desires to register a client(s) with Dempsey Auction Company for the aforementioned sale.

Dempsey Auction Company agrees to pay ___________________________________________ ten percent (10%) of the buyer’s premium collected, on said specific property, if their client is declared the successful purchaser, executes a sales contract and closes on said property.

Said brokerage firm acknowledges that this form must be submitted to the offices of Dempsey Auction Company twenty-four (24) hours prior to the advertised date and time of said auction. NO EXCEPTIONS

BROKERAGE INFORMATION

Agency: ___________________________________ Agent: ___________________________________

Address: ______________________________________________________________________________

City, State, Zip: ________________________________________________________________________

Phone No. __________________________________ Fax No.: _________________________________

CLIENT INFORMATION:

1. Registered Prospect: _________________________________________(Please Print)

Prospect Signature: _________________________________________

2. Registered Prospect: _________________________________________(Please Print)

Prospect Signature: _________________________________________

3. Registered Prospect: _________________________________________(Please Print)

Prospect Signature: _________________________________________

________________________________________ __________

Referring Broker Date

________________________________________ __________

Dempsey Auction Company, Broker Date

Please email to Katrina@ or fax at 706.291.2984.

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