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Contact Information
Name
Phone Number
Address	Street: City: State:    Zip:
Email Address
Housing Information
Area selection (city, state, zip)
Price Range
Type of property	Single Family Townhouse Condominium Income Property Ranch Lots & Land Retirement Vacation Other
Size of home/property
Number of bedrooms
Number of bathrooms
Nearby school(s) desired
Additional Preferences	New House (0-5yrs) Newer House (5-15yrs) Garage Pool Large Lot Near Park
Other Preferences (Please Specify...)
When to purchase	Immediately Within 2 Months Within 6 Months Within 1 Year Undecided
Need to sell your present home	Yes No
Prequalified by lender	Yes No
Need more information on financing	Yes No
Comments & Additional Info Request