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Postal Code

Primary Service Area *

Partner Type & Services

Which best describes your business? *

Real Estate Agent

Broker / Brokerage

Bank / Lender

Mortgage Broker

Home Inspector

Title / Escrow Company

Attorney

Insurance Provider

Other (please specify)

Other (please specify)

Experience & Credentials

Years in business

Alignment & Values

Why are you interested in becoming a partner with us?

How do you support clients beyond just completing the transaction?

Collaboration Style

Typical response time to clients or partners *

Same business day

Within 24 hours

24–48 hours

Are you open to joint marketing or educational initiatives? *

Yes

Possibly / depends

No

Volume & Capacity

Approximate number of transactions or clients you handle per year

Do you currently have capacity to take on additional clients? *

Yes

Limited

No

Compliance & Professional Standards

Have you ever been subject to disciplinary action, complaints, or licensing issues? *

No

Yes (please explain below)

If yes, please explain

Do you agree to operate in compliance with all applicable laws, regulations, and ethical standards? *

Yes

No

Programs & Client Benefits

Are you interested in participating in client-benefit or referral programs?

Yes

I’d like more information

No

Final Details & Confirmation

How did you hear about us?

Is there anything else you’d like us to know?

517 Luzerne Ave Suite 1A

West Pittston, Pa 18643

(570) 212-9218

[email protected]

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