Client / Builder Registration Form
 

Please be advised that _____________________________ has/have been referred to your community by our firm.  This client is represented by Value Realty as a Buyers Agent in pursuing a contract with your company.  Be certain Value Realty / Dan Lowenthal also appears on your purchase contract.


 
 
Our Client Information
 

Name:

______________________________________

 Address:

______________________________________

City:

______________ State:_______  Zip:________

Home:

_________________ Cell:_________________

   
   

Sign:

________________________ Date: _________

 
 

 
 

Please contact Dan Lowenthal  -  Broker / Owner  -  License #0362850

 at (Office) 713-540-7511 should you have any questions.

 

(Fax) 713-666-3151

 

Email: dan@texasnewhousecashback.com