Name: (Required)
E-mail: (Required)
Address:
City: State: Zip:
Day telephone:
Evening telephone:
Fax:

General Information About Your Move:

Are you relocating?	Yes    No
Where are you moving?
City: State: Zip:
When do you anticipate purchasing your new home?
within 4 months within 6 months within a year no date set

Information About The Home You Are Looking For:

Type of home:

Single family Condo/Townhouse Multi-family Mobile home Farm Land only

Approximately priced between:

50,000 75,000 100,000 150,000 200,000 300,000 400,000 500,000 1,000,000 1,000,000+ and 50,000 75,000 100,000 150,000 200,000 300,000 400,000 500,000 1,000,000 1,000,000+

Number of bedrooms

1   2   3   4   5   6+

Number of bathrooms:

1   2   3   4+

Interior Features & Preferences

Living room	Yes    No	Family room	Yes    No
Fireplace	Yes    No	Hardwood floors	Yes    No
Den/Study	Yes    No	Laundry room	Yes    No

Other Important Interior Features:

Exterior Features & Preferences

Swimming pool Yes    No Spa Yes    No Waterfront Yes    No Garage Yes    No Tile roof Yes    No Fenced Yes    No Other Important Exterior Features:

Additional Information

Have you ever been pre-approved or pre-qualified for a mortgage?  Yes  No

If yes, for how much?

Do you have a down payment?  Yes  No

If yes, what is your maximum commitment?

Have you had a credit report done lately?  Yes  No

If yes, any problems?  Yes  No

Please use this space for any other comments or questions you might have.