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Select one: Seller Referral Buyer Referral Other (please note in comments above)

This is confirmation of referral previously phoned: Yes No

Are you a New Referral? Yes No

Receiving Office: Remax Twin City Realty Inc. Attention:  Looey Tremblay 842 Victoria St. N. Kitchener, Ontario (519) 579-4110

Referring Re/Max Office:
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Client Information:
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Status of Present Home (if applicable):
Currently Listed At: Not Yet Listed (Will Sell for): Sold At Equity Renters
Must Client Sell First? Yes No
Reason for Move: Transfer New Job Other (include in comments above)
Move Definite: Yes No
Authorized: Yes No
Comments: