Broker Referral Request Form

Type of Transaction*

Your Information

The brokers that we refer are chosen strictly on the basis of being a good match for the specifics of your desired transaction and not because they have big hearts.

Full Name*

First Last

Email*

Phone*

Home Sale or Purchase

Price Range*

Desired Date of Closing*

Number of Bedrooms*

Number of Bathrooms*

Address of Home for Sale*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Desired Areas for Home Purchase

Desired Zip Code (if known)

Type of Property

Condo
Single Family Home

Description

Commercial Lease or Purchase

Address*

City State / Province / Region

Desired Area of City

Desired Occupancy Date

MM

DD

YYYY

Desired Caliber of Property

Class A
Class B
Class C

Type of Space

If Other*

Desired Square Footage

Charity I'd like to Receive Funding

Select If you would like a second Charity to receive part of the funding.

If your charity is not listed here, please contact us at info@iiconline.org;

How did you hear about IIC?

If an individual, please provide a name or email address. (optional)

Have a Broker in Mind?*

Yes! (IIC will make the arrangements so your favorite charity can benefit.)
No

Broker's Name*

Broker's Email Address*

Language Preference or Other Special Qualifications

Date

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