| BROKER - CLIENT REFERRAL REGISTRATION FORM | 
| Lloyd's Real Estate is pleased to welcome participating co-brokers and their clients to our properties and services. 
 In order to participate in the co-brokerage referral program, please complete the information below and submit it to our office in advance of your client's first contact. 
 We will be pleased to pay you a Broker Referral Fee of 25% from our received commission. 
 The Real Estate Agent/Broker referral relationship is protected for 180 days from the client's registration. 
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| We will send you a confirmation e-mail with your information captured onto the agreement once we have confirmed that prospect is not already in our Data Base. |