Name: 

Phone Number: 

Email Address: 

Preferred Method of Contact:  Phone Email

Best Time to Contact You: 

Preferred Areas (City, Community, Subdivision): 

Type of Property:  Single Family Town Home Condominium Income Property Ranch Lots & Land Retirement Vacation Other

Price Range:  $  to  $

Size of Home/Property: tosquare feet

Number of Bedrooms: 

Number of Bathrooms: 

Nearby Schools: 

Additional Preferences:  New Home (0-15 Years) Newer Home (5-15 Years) Custom Home Garage Pool Large Lot Near Park

Other Preferences (Please Specify):

When to Purchase: Now! Within 2 Months Within 6 Months Within 1 Year Undecided

Do You Need to Sell Your Present Home?  Yes No

Have You Been Prequalified by a Lender?  Yes No

Do You Need More Information on Financing?  Yes No

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