1. Contact Information (* indicates a required field)
First Name: *

Last Name: *

Phone:

Fax:

Email: *
Street Address

City:

State/Province:

Zip/Postal Code:
   
2. Property Information (Describe the home that you wish to buy)
In what area do you want to purchase?

Property Type: (Single-Family, Condo, Duplex, etc.)

Number of Bedrooms:

Number of Bathrooms:

Approximate Square Footage of Home: (for example, about 2000 sq. ft.)

Lot Size: (small, large, 1 acre, etc.)

Age of Home (new, 10 years, etc.):

Type of school desired to be nearby?
Elementary
Middle School
High School
Unnecessary

When do you plan to purchase?
Immediately
1 to 3 months
4 to 6 months
More than 6 months
Undecided

Do you need to sell your present home?
Yes
No

Have you been prequalified by a lender?
Yes
No

Do you want more information on financing?
Yes
No

What would be the best time to reach you?

Additional features or comments?

Are you currently working with another REALTOR®?
Yes
No