Your Name
Local Address
City
State Zip
Daytime Phone
Evening Phone
When are you at this location?
Permanent Address
City
State Zip
Daytime Phone
Evening Phone
Email
(Information will be sent to this address.)
When do you plan to move?
  In 6-9 months Over 1 year from now
  In 9 months - 1 year  
What size/type of residence are you primarily interested in?
  Town Home Two Story
  Single Story 3-Bedroom
  2-Bedroom 4-bedroom
What price range are you interested in?
  $150,000 - $175,000 $225,000 - $250,000
  $175,000 - $200,000 $250,000+
  $200,000 - $225,000  
What is your reason for purchase?
  Primary residence Second home
  Investment property Corporate Use
How did you hear about us? (Please check all that apply)
  Newspaper Magazine
  Referral Broker
  Internet Mailer
  Driving by Other
Thank you. You'll be hearing more from us soon
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