Name (First, Last)

Address:City:

Zip: Daytime Phone:    Evening Phone:

E-mail:

I presently Own Rent If you own, do you need to sell your present house Yes No      

I am looking for  Please Select Single Family Home Condo/Co-op Townhouse/Twin Multi-Family Land Farm   Price Range
Have you been prequalified or pre-approved for a mortgage? Yes No
Would you like to meet with a mortgage professional? Yes No

Basic Features

Number of Floors Please Select Single Two Three or more Approx. Square FeetLot Size
Bedrooms Please Select One Two Three Four Five Six or more             Baths 1 1.5 2 2.5 3 3.5 4               Laundry Please Select Basement 1st Floor 2nd Floor
Basement Please Select None-Slab Crawl Space Full Concrete                  Parking Please Select Garage 1 car Garage 2 car Garage 3 or more Carport Off Street On Street

Planning to Buyl ASAP 30 days 60 days 90 days 6 months 9 months 12 months How did you hear about this site Please Select Search Engine Newspaper Ad Newsletter Friend/Relative Web Link

What special features would you like (check all that apply)