1. Area Selection:

2. Housing Information:

Price range?	Select an option. $150,000 to $250,000 $250,000 to $350,000 $350,000 to $450,000 $450,000 to $550,000 $550,000 to $650,000 $650,000 to $750,000 $750,000 to $1,000,000 Over $1,000,000
Type of home?	Select an option. Single family Town house Condominium Other
Size of home?	Select an option. 1,000 to 2,000 sq. ft. 2,000 to 3,000 sq. ft. 3,000 to 3,500 sq. ft. over 3,500 sq. ft.
Bedrooms?	Select an option. One bedrooms Two bedrooms Three bedrooms Four bedrooms Five bedrooms
Bathrooms?	Select an option. One bathroom Two bathrooms Three bathrooms Four bathrooms
Desired school nearby?	Select an option. Elementary Middle school High school
Age of house?	Select an option. Under 5 years Under 10 years Older than 10 years
When to purchase?	Select an option. Immediately Within 2 months Within 6 months Within 1 year Undecided
Need to sell your present home?	Select an option. Yes No
Prequalified by a lender?	Select an option. Yes No
More information on financing?	Select an option. Yes No

3. Contact Information:

Your name*
Your e-mail address*
Your phone number*

What is the best time to contact you?

Select an option. Please call daytime Please call eveningtime

What would be the best time(s) to reach you?
Example: 5pm-10pm

Are you currently working with another REALTOR?

Yes No

4. Please mail me a personalized MLS list of homes in my range.
Note: Be sure to fill out below the mailing address information to receive the MLS list!

Mailing Address:

Street:

City:

State:

Zip:

Any extra comments, or specifics you would like to add:

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