Your Information

First and Last Name:  

E-mail Address:          

Street Address:           

City:                                    State:

Zip code:                      

Home Phone:                     Work Phone:    

Cell Phone:                         Facsimile:        

Best time/method to contact you?    Evenings Mornings Any Time     via    Email Home Phone Work Phone Cell Phone Fax

Home Requirements:

Areas/cities of interest?   

Property Type Desired:    Any Condominium Townhome Income Property Land Single Family Home

Number of Bedrooms:      Any 1 2 3 4 5      Exactly or more or less

Number of Bathrooms:     Any 1 2 3 4 5      Exactly or more or less

Square Footage Preferred:              Any Minimum or more

To Serve You Better:

How long have you been looking for a home?         Months Years

Have you seen any homes you like?                     None No Yes

Do you currently rent or own?                                 Rent Own

Price Range:                                                            $0-$150,000 $150,000-$200,000 $200,000-$250,000 $250,000-$300,000 $300,000-$350,000 $350,000-$400,000 $400,000-$450,000 $450,000-$500,000 $500,000-$550,000 $550,000-$600.000 $600,000-$700,000 $700,000-$800,000 $800,000-$900,000 $900,000-$1,000,000 over $1,000,000

How much downpayment do you have in mind?      Dollars Percent

What monthly payment would you feel comfortable with?   

Are you pre-qualified with a lender?                    Yes No

How soon will you be able to move?                   Immediately 1-6 months 6-12 months    or date: 

Additional Comments or Questions: