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Broker Referral Request Form

AGENT REFERRAL REQUEST FORM

"*" indicates required fields

Type of Transaction*

Charity I'd like to Receive Funding

Can also include an eligible individual or cause (e.g., teacher, nurse, etc.).

Your Information

The agents 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*

MM slash DD slash YYYY

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

Other

If "Other" was selected above, please describe.

Description

Commercial Lease or Purchase

Address*

City State / Province / Region

Desired Area of City

Desired Occupancy Date

Month

Day

Year

Desired Caliber of Property

Class A

Class B

Class C

Type of Space

Office

Retail

Warehouse/Industrial

Medical

Other

If Other*

Desired Square Footage

1,000

1,000-5,000

5,000-10,000

10,000-20,000

20,000-50,000

50,000+

Hidden

How did you hear about IIC?

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

Have an Agent in Mind?*

Yes! (IIC will make the arrangements so your favorite charity can benefit.)

No

Agent's Name*

Agent's Email Address*

Language Preference or Other Special Qualifications

Date

MM slash DD slash YYYY

CAPTCHA

Investing In Communities® was established in 1995
as a program of MAP Real Estate, Inc.

Chicago metropolitan region, Illinois
Illinois License # 478.005575

Michael A. Pink
Designated Managing Broker
Illinois License # 471.005241
312-527-3030
mp@maprealestate.com

IIC is located in the Chicago metropolitan region, Illinois
and operates throughout the United States.
312-955-4900
info@iiconline.org

Conceived & Underwritten by MAP Real Estate, Inc., a Certified B Corp and BFTW™ 2022-Community
MAP Real Estate, Inc. has an Illinois broker license, so brokerages in any state can pay us referral fees in compliance with their respective state's license regulations. We give those referral fees to charities chosen by buyers and sellers.
©2025 Investing in Communities®

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