Name    

Phone #

E-mail  

How did you hear about us?       Drive byNewspaperRealtorReferralOther             

How soon would you like to move?  Within 30 daysWithin 3 monthsWithin 6 months             

What is your price range?          300,000 to 350,000350,001 to 400,000400,001 to 450,000450,001 to 500,000                                   

What size home do you want?     Under 3000 sf3000 - 32003200 - 35003500 - 4000Over 4000

Bedrooms                                  

Bathrooms

Do you have a Home to sell? Yes No