PROSPECT REFERRAL FORM
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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