The 
Renovation Co-op

The National
Realtor Program

Thank you for your inquiry

Please fill out the following profile and contact information:

Real Estate  Broker/Agent Profile
First Name Last Brokerage Company

Are you a principle?

 Yes No

Agent working under a broker's license?

 Yes No

Sales Rep working as part of a Mortgage Broker's
team that operates under a main brokerage license?

 Yes No

Home Office

Main Office

 Cell Fax

Personal E-Mail

Mailing Address City Province

Postal Code

Experience

Residential

Commercial

 Both Residential & Commercial

Location:

 Rural City Both

Type:

Real Estate Broker

Real Estate Agent

Other:

Years in Industry:

 Years

Years as a Real Estate Broker (if Applicable: 
Years

How did you hear about us?

Radio

 T.V.

Billboard

Contacted by Company

Other:

Do you work out of a Real Estate Office?

 Yes No
What percentage of your clients are Residential?

%

Commercial?

%

What percentage of your business is new (non-referred) sales?

%

Have you ever sold a home that was financed through a Purchase-Plus Improvement Mortgage?

Yes

No

Best times and days to call:

Best phone number(s):

Comments

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