Name* (* denotes required fields)
Email: *
Address:
City: State: Zip:
Day telephone:*
Evening telephone:
Fax:
General Information About Your Move:
Are you relocating? Yes    No
Where are you moving?
City: State: Zip:
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

Approximately priced between:

and

Number of bedrooms
1   2   3   4   5   6+
Number of bathrooms:
1   2   3   4+
General Interior Features & Preferences
Formal Living room  Yes    No Family room   Yes    No
Fireplace   Yes    No Hardwood floors    Yes    No
Den/Study   Yes    No Laundry room   Yes    No
Formal Dining room  Yes    No
Other Important Interior Features:
General Exterior Features & Preferences
Swimming pool Yes    No Tile roof Yes    No
Waterfront Yes    No Fenced Yes    No

Other Important Exterior Features:
More Specific Information
Garage Garage Location Need minimum of 20 feet to turn
into a garage from side
Kitchen and Eating Area:
Eat-in Kitchen  Yes    No Peninsula bar for eating   Yes    No
Breakfast room   Yes    No Open to family room    Yes    No
On rear of home   Yes    No On front of home   Yes    No
Appliances:
Range  Yes    No Cooktop   Yes    No
Dishwasher   Yes    No
Walk-in closets: Yes    No
 Location of Master Bedroom:
Apart from other bedrooms Yes    No In back Yes    No
In front Yes    No Sitting area in master Yes    No
 Master bedroom features:
Garden tub  Yes    No Size of shower   Sq.Ft
2 Vanity bowls   Yes    No Separate vanities    Yes    No
Toilet Compartment   Yes    No
 Other rooms:
Game room  Yes    No Play room   Yes    No
Exercise room   Yes    No Spa room    Yes    No
Sun room   Yes    No
Additional Information
Have you ever been pre-approved or pre-qualified for a mortgage?  Yes  No
          If yes, for how much?
Do you have a down payment?  Yes  No
          If yes, what is your maximum commitment?
Have you had a credit report done lately?  Yes  No
          If yes, any problems?  Yes  No

Please use this space for any other comments or questions you might have.