Please provide the following contact information:

*First Name
*Last Name
*Street Address
Address (cont.)
*City
*State
*Zip Code
*Phone
E-mail

Tour Date I am Interested in:

-- mm/dd/yy

Primary Interest:

Investment
Primary Residence
Both

Type of Investment:

Home
Condo
Townhome
Investment Property (Duplex, Triples, and more)
Handyman Specials

Loan Approval:

Currently have Loan Approval Letter
I want Free Loan Approval
      (Checking this box gives us authorization to have a loan rep. contact you)

Interested in Viewing Homes in Value:

0 - $100,000
$100,000 - $200,000
$200,000 - $300,000
$300,000 +

Number of seats I would like to reserve (Max 2 per registration):

1 2 No seat, please call me

How did you hear about us?

TV
Radio
Newspaper
Saw the Bus
Internet
Magazine
Billboard
Referral
Other

I acknowledge that by submitting this Buyer Registration; As a potential buyer, I grant Keith Kelly - Dickerson & Neiman Realtors (Broker), the exclusive right to assist me in the acquisition of available properties that I have been introduced to while on the Foreclosure Tour Bus or by Keith Kelly (Agent).
 

As a potential buyer, I authorize the broker to operate as a Transaction Broker for purposes pertaining to the purchase of any property.
 

I, hereby, certify that I am not a Licensed Real Estate Agent, Loan Originator or represented by a real estate agent.

Buyers shall indemnify and hold harmless Dickerson & Nieman Realtors and all agents associated with Foreclosure Tours from any and all claims, damages, suits, and expenses caused by or arising out of the acts, omissions, errors or negligence of Keith Kelly and Dickerson & Nieman Realtors or agents thereof.

 ** I have read and understand the above information (Type your initials here - Must be 3 letters)

The broker has professional skills and knowledge in assisting you with negotiation and sales contracts. Traditionally, the broker is compensated by the seller. This compensation does not compromise the broker's duties to the buyer. The broker adheres to the principals expressed in the Fair Housing Act. The broker does not warrant or guarantee products or services provided by any Third Party whom the broker, at the buyer's request, refers or recommends to the buyer in connection with any property acquisition.