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Referral Agent Registration Form

You may register for ALL of our out bound referrals for your state or area.  By doing so, you agree to refer ALL of your in bound clients to me and place a link on your web site.

Please copy the following code and paste it on your site as a DIRECT link, once this is done contact me at info@markhastings.net.

<p>Moving to Virginia ?&nbsp;&nbsp;
<a href="http://www.markhastings.net">Fairfax County Real Estate </a>&nbsp;Mark
Hastings, Re/Max Gateway.</p>

ALL REFERRALS MUST BE MADE BY A LICENSED AGENT WORKING FOR A LICENSED BROKER IN ACCORDANCE WITH 54.1 OF THE VIRGINIA CODE!!

AGENT/BROKER INFORMATION

Your First Name  

Your Last Name  

Your Brokerage Firm's Name  

Your Brokerage Firm's Address                    

 

Your Brokerage Firm's Tax I.D.

Your Brokerage Firm's Phone Number --       

                                                     Fax --

Your e-mail Address

Your Web Site

You have read and agreed to our terms and conditions          No         Yes

 

  


4090-B Lafayette Center Dr.
Chantilly, VA 20151

Office: 703-652-5702
Fax: 703-263-2510
E-mail: info@markhastings.net



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