Top Tier Realtor                                                  Partner Agent Customer Intake Form
Information you provide on this form will be used to create your Google Local Services Ad. It's important that this information is 100% accurate. (
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First name *
Last name *
Email address *
Website address *
Broker's name

Choose your primary service areas (cities or county) where you want to get leads from. You will be responsible for paying for these leads.  *

The best phone number for you to receive text messages of new leads.

What year did you start your current RE business? *
If you have a free Google business profile/page, please enter the name of it here, along with a link to it. *
If you have a free Google business profile/page, enter the address where you verified it. Google most likely mailed you a postcard to this address with a PIN number. If you don't have a Google business profile, enter your home address. *
If you do not have a free Google business profile/page, what would you like for the name of your new Google Ad to be? We recommend the following: "{Your name}, Realtor - {Your brokerage}" *

RE License info: The name your license is registered under, license #, and expiration date


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