Contact Information

First name: Last name:

Home phone/Area code: Number:

Cell phone/Area code: Number:

Email address:

Mailing/Street address: Unit #:  

City: State: Zip code:

Property Information

What is your price range?    First time buyer: Yes No 

What type of property do you want?

Condo     Townhouse     Single Family     Land     Commercial

 #/Bedrooms:      #/bathrooms:     Sqft:     

Pool     Spa    Other:  

 Zoning/Land & Commercial only:  

What location are you looking for? 

City:   State:   Area:

If selling to buy, what is the selling property address?

Selling property/address: Same as above     (If different fill out address below.)

Selling property/Street address:  

Unit #:  

City: State: Zip code:

Finance Information

What do you want to pay per month?  

How much money on hand do you have to work with?  

Source of down: Savings     401k     Family/friends     Don't have down, but have excellent credit and income.

Can you tell us more?

Do you need to sell your property before buying? Yes No 

When are you ready to buy?

Now        30 days        90 days        6 months        1 year

What questions do you have?

Brief survey

How did you hear about us? Internet TV/cable Newspaper  Homes

& Land Magazine Yard sign  Bus bench    US mail  Email message 

Past client        Other: