Agent Referral This is a new...(Required) Tenant Referral (Tenant Showing) Property/Owner Referral Inspection Confirmation Owner Name(Required)Please enter the principal property owner's name: First name Last name Owner Phone(Required)Please enter the principal property owner's phone number:Tenant Name(Required)Please enter the principal tenant's name: First name Last name Tenant Phone(Required)Please enter the principal tenant's phone number:Property Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Agent Brokerage Affiliation(Required)If you are not a Reliant Realty agent, a completed W-9 Form for your brokerage (PDF format) must be uploaded in order to submit this form. If required, click here to complete and save a W-9 form to upload below. Reliant Realty Other Reliant Realty Office(Required)Please select your home Reliant Realty office Clarksville, TN Franklin, TN Gallatin, TN Murfreesboro, TN Nashville, TN Boynton Beach, FL Royal Palm Beach, FL Brokerage Name(Required) Brokerage Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Brokerage Phone Number(Required)Agent Name(Required) First Last Agent Phone Number(Required)Agent Email(Required) Completed W-9 Form(Required)Please upload a completed W-9 Form (PDF format). If required, click here to complete and save a W-9 form to upload.Accepted file types: pdf, Max. file size: 50 MB.Referral Terms Acknowledgment(Required)Referrals will only be paid on property/properties being onboarded at the initial owner introduction. Property addresses must be included in the agent referral form submission to qualify for the referral. Should the property owner choose to place additional properties into management with Secure Property Management after the initial owner agreement is signed, those properties do not qualify for an agent referral. If more than one property is being referred in the initial introduction, the agent will be paid in 12 equal monthly installments after a tenant is placed in the referred properties. I acknowledge the above terms.EmailThis field is for validation purposes and should be left unchanged.