Name*

Address*

City* State* Zip*

Home Phone* Work Phone

E-mail Address*


Do you currently: Select Own Rent Other

When do you plan to move? Select Within 30 Days 1-3 Months 4-6 Months 6 Months or More

What prompted your pending move? Select Out of State Relocation First Home Purchase Need Larger Home Need Smaller Home Other


How did you find out about us? Select Newspaper Ad Magazine Ad Realtor Signage Web Search Other

Price range of new home: Select $190,000-$225,000 $225,000-$250,000 $250,000-$275,000 $275,000-$300,000 $300,000-$325,000 $250,000-$300,000 $300,000-$325,000

How would you prefer to be contacted: Select Postal Mail Telephone E-mail

Floor plan features desired (Select all that apply):
   1 Bedroom, 1 Bath
   2 Bedrooms, 2 Baths
   Flat     Town Home
   Study     Garage
   1st Floor Preference
   2nd Floor Preference
   3rd Floor Preference


Are you working with a realtor? Select Yes No Looking for one

Realtor’s Name

Realtor Agency’s Name


Are you prequalified for a mortgage? Select Yes No In Process

Lender's Name


Would you like assistance with financing? Select Yes No

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