* indicates required fields
CONTACT INFORMATION
*
First Name:
*
Last Name:
*
Email:
*
Phone:
Address:
City:
Zip Code
GENERAL INFORMATION ABOUT YOUR MOVE
Do You Currently Own a Home?
select one
Yes
No
When do you anticipate
purchasing your new home?
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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:
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$0
$10,000
$20,000
$30,000
$40,000
$45,000
$50,000
$55,000
$60,000
$70,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
$5,000,000
$6,000,000
$8,000,000
$10,000,000
and
select one
$10,000
$20,000
$30,000
$40,000
$45,000
$50,000
$55,000
$60,000
$70,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
$5,000,000
$6,000,000
$8,000,000
$10,000,000
Number of Bedrooms:
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1
2
3
4
5
6
Number of Bathrooms:
select one
1
2
3
4+
Interior Features & Preferences:
Living Room
Family Room
Fireplace
Hardwood Floors
Den / Study
Laundry Room
Other Important Interior Features:
Exterior Features & Preferences:
Swimming pool
Spa
Waterfront
Garage
Tile roof
Fenced
Other Important Exterior Features:
ADDITIONAL INFORMATION
Have you ever been pre-qualified for a mortgage?
No
Yes
Do you have a down payment?
No
Yes
Have you had a credit report done lately?
No
Yes
Please use this space for any other
comments or questions you might have.