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 Yahoo search Google search Homegain Other Internet search engine Link from another website Magazine ad Referral from a friend or family member Business card I am a past client Other

Please use this space to elaborate in your own words how you found us

Contact Information

Your Name

Phone Number

Fax Number

Email Address

Best time to contact you

Housing Information

Area selection (city, state, zip)

Price Range

Maximum Monthly Payment Desired

Type of Property

 Single Family Home Income Property Townhouse Cooperative Condominium Ranch Lots & Land Retirement Vacation Other

Min. Square Footage

 1000-1500 2000-2400 1500-1800 2400-2800 1800-2000 2800+

Number of bedrooms

Number of bathrooms

Nearby school(s) desired

Additional Preferences

 New House (0-5 yrs) Garage Large Lot Newer House (5-15 yrs) Pool Near Park

Other Preferences(please specify)


 yes no

If yes to above – from where?

Are you a first time home buyer?

 yes no

When to purchase?

 Immediately Within 6 Months Undecided Within 2 Months Within 1 Year

Need to sell your present home?

 yes no

Prequalified by lender?

 yes no

Need more info on financing?

 yes no