Please provide the following contact information: ( * ) REQUIRED FIELDS

First name	*
Last name	*
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Cell Phone
Work Phone	*
Home Phone	*
FAX
E-mail
Contact	Choose Best Time To Contact You Morning at Home  Morning at Work  Morning on Cell Phone Afternoon at Home  Afternoon at Work  Afternoon on Cell Phone Evening at Home  Evening at Work  Evening on Cell Phone

What style of home do you prefer? Traditional, Colonial, Contemporary, French, etc.

What would be the most important thing about your new home?

What rooms do you need vs. prefer? Gameroom, Study, Formal Living, Formal Dining, etc.

What features and amenities are most important to you? Open, Island Kitchen, Tile Floors, etc.

Number of Stories?       Select any of the following options that apply:

One story      Two story      No preference  

Desired Age of New Home?   Select any of the following options that apply:

New
Less than 5 Years
5 to 10 Years old
Less than 25 Years
Doesn't Matter

House price range?

Select price range 50-60,000 60-70,000 70-80,000 80-100,000 100-120,000 120-140,000 140-160,000 160-180,000 180-220,000 220-280,000 280-340,000 340-500,000 500,000+  *

Approximate Square Footage?      Select any of the following options that apply:

Less than 1500  1500-2000       2000-2500      2500-3000     
3000-4000       4000-5000       5000+           

How many Bedrooms?

How many Baths?

Would you like a pool?

No Preferance Yes, a must. Yes, if possible No

Would you like a Fireplace?

Yes No

How many Garage Spaces?

What area of town do you work?

What area or Where do you want to live?

Do you have a Home to Sell before you buy?

Yes No

When would you like to move into your New Home?

-- mm/dd/yy

Is this a Company Transfer or Relocation?

Yes No

What is your Desired Monthly Payment?

Anticipated Down Payment?

Have you Already selected your new Loan Officer and been Pre-Qualified for the Price Range you checked in the previous question?

Yes No

Did you have a list of homes for which you need information.  Whether you found them on this website or somewhere else list them below and the information will be forwarded to you promptly.

Do you need information on certain areas of town?

Any Questions or Comments?

Are you working with another Real Estate Agent? Yes No, I want you to represent me and help me find my new house. No, I haven't selected a personal Realtor yet. *