Please fill out the short form below to give us more information about what type of home you are looking for. We will contact you as soon as we have found properties that meet your criteria! Name: Address: City: State: Zip: Home Number: Work Number: Email Address: What Localities, City, and State are you interested in moving to? Number of Children: Age of Children: Would you like school information? Yes No Approximate Move Date: Immediately 1 - 3 months 3 - 6 months 6 - 9 months 9 - 12 months 12 - 24 months Over 24 months Upon sale of current home Undecided Do you currently own a home? Yes No If yes, what do you own? House Condo Townhome What do you plan to buy? House Condo Townhome What is the Price Range of your dream home? 1MM + 750K - 1MM 500K - 750K 400K - 500K 325K - 400K 250K - 325K 175K - 250K 125K - 175K Under 125K What is your current household income? 300K + 200K - 300K 100K - 200K 75K - 100K 50K - 75K 25K - 50K Under 25K Have you been pre-approved by a mortgage lender? Yes No Comments/Ideas:

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