| Receiving Agent | | Sending Agent |
|---|
| Name: L Richard Black | | Agent Name: |
| Office: RE/MAX 2000 Commercial Division | | Office Name: |
| Address: 1560 W Warner Rd, Gilbert, AZ 85233 | | Address: |
| Email: rickblack@remax.net | | Agent Email: |
| Phone: 602-697-0745 | | Agent Phone: |
| Fax: 480-507-2020 | | Agent Fax: |
Client Information |
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| | Client Phone: |
| | Client Mobile Phone: |
| | Additional Information: |
Property Information |
| | Property Type(s): |
| | | Desired or Current Location(s): |
| Do they have a contractual agreement with another agent/agency? |
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