How do you prefer we contact you?
Home Phone Work Phone

When is the best time for an Agent to call you?
Morning Afternoon Evening

Are there children in the family?
No children 1 child 2 children 3 children 4 or more children

What school options are important?
Grades K-6 Grades 7-9 Grades 10-12
College, University, or Other School

When are you planning to buy?
As soon as possible 1 to 3 months 3 to 6 months 6 to 12 months
When present home is sold Undecided

Is this a work related move?
Company Relocation New Job Considering moving and need more information.

Have you Qualified or Pre-Qualified for a mortgage?
Pre-Qualified Qualified (Loan is fully approved)
Have not applied for a mortgage yet

Price range?

$75,000 to $100,000
$100,000 to $125,000
$125,000 to $150,000
$150,000 to $200,000
$200,000 to $250,000
$250,000 to $300,000
$300,000 to $350,000
$350,000 to $400,000
$400,000 to $450,000
$450,000 to $500,000+
Other (Please Specify)

How many Bedrooms? (Check all that apply)
2 Bedrooms 3 Bedrooms 4 or more Bedrooms

How many Bathrooms? (Check all that apply)
1 Bathroom 2 Bathrooms 3 or more Bathrooms

Any other preferences? (Check all that apply)
Single Family Home
Duplex
Condo/Townhouse
Wheelchair Accessible
Other: (Please Specify)

Comments:

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