Full Name
Home Phone
Work Phone
Fax Number
Pager Number
E-mail
Number of Bedrooms Desired
Number of Bathrooms Desired
Do you want a pool?	yes no
Do you want a spa?	yes no
Number of Garage Bays Desired
What is the price range of the house you are looking for? Between  and
Which cities would you like to live in?
How many stories do you want - check any or all 1 Story | 2 Story | 3 Story
What square footage do you want your house to be? Between  and
How large do you want the lot - check any or all 1/4 acre 1/2 acre 1 acre other
When would be most convenient for you to move? 30 days | 60 days | 90 days | 6 months | 1 year
Are you currently using a lender?	yes no
If yes, who is your lender?
Are you pre-approved?	yes no
Is your house listed now?	yes no
If yes, who is the house listed with?
What is your home address?
Address
City
State
Zip
Please write three things in a home you can't live without: