Form

Contact Information
This is the information that our referral partners will use to contact the client
Client Name*
Name*
Preferred Name*
Address*
Address 2*
City*
Province*
Postal Code*
Email*
Phone*
Mobile
LEGACY REIA Contact Information
LEGACY FLP Name*
LEGACY REIA Phone Number*
LEGACY FLP Email Address*
LEGACY FLP Mobile Phone*
Intake Form
This information is for use by our referral partners in preparing for your first meeting.
Type of Service*

REALTY

Seeking immediate financing assistance

Financial review of existing portfolio

New Investor getting started

LEGACY Other

ALLREIAStat
Specific purpose of Introduction*
Date of Birth*
Marital Status*
Current Employer*
How many years?*
If less than 5 years, previous employer*
How many years with previous employer.*
Do you own a residence?*
Mortgage Amount
Confirmation of informed consent
Referral requires completed consent form. Please Put full Name below if everything above is true.
Signature*
Signed Consent Form*

* required information

For security purposes, please type the letters and numbers you see below.

Contact Information