Application Form for Referral Program


Marcy Portugal and Paul Portugal of the Keyes Co. Realtors in Tequesta are seeking reputable service companys relating to services for the home such as roofers, plumbers, etc. to join our exclusive advocate network. Marcy and Paul would like to establish a business relationship with these companies where the companies would be exclusively referred to the clients doing business with Marcy and Paul. Only three companies per service industry type will be selected. Selection is based on first-come-first serve. Please provide us with the following information to be considered for the program:


Company Name: _______________________________________________


Company Address: _____________________________________________


Company Contact: _____________________________


Company Phone #: _____________________________


Years of Service: _______________________________


Type of Service: ________________________________



Client References ( will be contacted for testimonial )

please provide client contacts of where work was performed within the last 4 months


Client #1: ____________________________________________


Phone #: ______________________________________________



Client #2: ____________________________________________


Phone #: ______________________________________________



Client #3: ____________________________________________


Phone #: ______________________________________________




Business Owner Signature: ____________________________


Printed Name: _______________________________________


Date: _______________________________________________


Thank you for your interest in participating in this program.