Full Name
Home Phone
Work Phone
Fax Number
Pager Number
E-mail
Number of Bedrooms in your home
Number of Bathrooms in your home
Do you have a pool?	yes no
Do you have a spa?	yes no
Number of garage bays you have
What is the price range you want to list your house for? Between  and  OR I need help in figuring out the selling price
How many stories is your house? 1 Story | 2 Story | 3 Story
What is the square footage of your house?
How large is your lot?
When would be most convenient for you to move? 30 days | 60 days | 90 days | 6 months | 1 year
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 about your home that someone would like