Agent Qualification Form

First Name:
Last Name:

Address:
City: State: Zip Code:

Home Phone:     Office Phone:
Voice Mail:     Pager:
Cell Phone:        Fax:
E-Mail:

Personal Web Site:

Real Estate License Number:

Name of Broker:
Broker's Agency Name:

Agency Address:
City: State: Zip Code:

Broker Tax ID:

Agency Phone: Agency Fax:

Agency Web Site:

Please tell us about you and your real estate experience.

Please tell us about any real estate designations and sales awards you have earned.

Number of Years as a Licensed Full Time Real Estate Professional.

Number of Listings This Year:

Number of Listings Sold This Year:

Number of Buyer Sales This Year:

Total Number of Listing and Buyer Transactions Last Year:

Dollar Amount of Real Estate Sold Last Year $

What Percentage of Business is Farm or Equestrian Property:

What other Type of Business Do You Work in? (select all that apply)

New Homes    Pre-owned Homes
Single Family    Townhouse    Condominium
Buyers    Sellers    Local    Relocation
Under $100,000    $100,000 to $250,000    $250,000 to $500,000
$500,000 or over

Other:

What Areas Do You Prefer To Work? (please describe in detail)

Do You Have a Licensed Partner? Yes No

Do You Have Licensed or Unlicensed Assistant(s)? Yes No

Do You Use a Computer Based Contact Management System such as Top Producer, Online Agent etc?
Yes No If Yes, What Contact Management Program:

Do You Have the Ability to "E-Mail" Clients or Prospects Information About Homes Listed on Your Area Real Estate Multiple Listing Service?

What is the link for your Banner to be used in a banner ad? or you can email the banner in GIF or JPG format to info@equinerealestate.com