First Name

Last Name

Email Address

Company Name

Street Address

City

State Select One Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebrasksa Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Postal Code

Business Phone

How many years have you been working in the Mortgage Industry?

About how many lenders do you and/or your company have access to?

What loan products do you specialize in?

Currently, about what percent of your business is refinance based? Select One 0% to 10% 10% to 20% 20% to 30% 30% to 40% 40% to 50% 50% to 60% 60% to 70% 70% to 80% 80% to 90% 90% to 100%

Currently, about what percent of your business is purchase based? Select One 0% to 10% 10% to 20% 20% to 30% 30% to 40% 40% to 50% 50% to 60% 60% to 70% 70% to 80% 80% to 90% 90% to 100%

Describe how you would like those percentages to change in the next 12 months:

How many loans did you write in the last 12 months?

How many loans would you like to write in the next 12 months?

How many Realtors would you like to meet through The Ibis Group's Professional Introduction Service?

Do you currently have any purchase business you would be willing to refer to a Real Estate Professional? Select One Yes No

Currently, are you working with any Real Estate Professionals? Select One Yes No

How did you hear about The Ibis Group and/or our Professional Introduction Service? Select One Lending Success Magazine Mortgage Market Guide Red Magnet Marketing Right Path Marketing Cilix Workplace Mortgage Solutions Greg Frost Telephone Conference Sue Woodard Telephone Conference Bill Sparkman Telephone Conference Bill Sparkman Live Seminar Event Your Company's Newsletter/Communication Your Company's Preferred Vendor List Trade Publication Trade Show or Convention Direct E-Mail Seminar Search Engine (Google, Yahoo, etc.) Friend or Co-Worker Referral TV Radio Other

Briefly describe your personal strengths, skills or achievements that might make you appealing to a Realtor

Briefly describe how you think The Ibis Group's Professional Introduction Service might benefit your business