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Name (required):
E-mail (required):
Day Telephone:
Evening Telephone:
  General Information About Your Move
Are you relocating?
  Yes    No
Where are you moving?
When do you anticipate purchasing your new home?
  Information About The Home You Are Looking For
  Type of Home:
Single Family Condo/Townhouse Multi-family
Mobile Home Farm Land Only
  Approximately priced between: and
  Number of Bedrooms: 1   2   3   4   5   6+
  Number of Bathrooms: 1   2   3   4+
  Interior Features & Preferences:
Living Room Yes    No Family Room Yes    No
Fireplace Yes    No Hardwood Floors Yes    No
Den / Study Yes    No Laundry Room Yes    No
  Other Important Interior Features:
  Exterior Features & Preferences:
Swimming pool Yes    No Spa Yes    No
Waterfront Yes    No Garage Yes    No
Tile roof Yes    No Fenced Yes    No
  Other Important Exterior Features:
  Additional Information
  Have you ever been pre-approved or pre-qualified for a mortgage? 
  No  Yes   If yes, for how much?
  Do you have a down payment? 
  No  Yes   If yes, what is your maximum commitment?
  Have you had a credit report done lately? 
  No  Yes  If yes, any problems?  Yes  No
  Please use this space for any other comments or questions you might have.