Customer
First Name:
Last Name:
Street:
City:
State:
Phone:
E-mail:
Fax:
 Real Estate Agent
First Name:
Last Name:
Company:
E-mail:
Phone:
Fax:
 About The Customer
Neighborhood /
Community:
Price Range:
Bedrooms:
Bathrooms:
Approximate Sqft:
Time Line:
 Type of Agency (Must select one)

Please fax Buyer Agent Agreement to 315-752-0324, attention Michael Asterino

Agent Registration in effect for 90 days from today with 90 day renewal upon Personal Contact with listing Broker: Michael Asterino