Name                                

Address                             

City, ST Zip                        

Telephone                          

email:                                

Best Time To Contact          

Housing Information      

Single Family

Townhouse

Condominium

Income Property

Lot / Land

Other

Style of Home      

1 Story Home

1 1/2 Story Home

2 Story Home

Garden Home   

Price Range                            

Size of Home                   

Number of Bedrooms        

Number of Bathrooms       

City (Area) Preference        

Schools Preference           

Other Preferences

New Home

Home 5 - 10 Years Old

Older

Basement

Additional Preferences

When to Purchase

Immediately

Within 6 Months

Within 1 Year

Not Sure

Need to Sell Your Present Home

Yes

No

Prequalified by Lender

Yes

No

Need More Information

Yes

No

Other Comment

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