Name:           

Address:                     City: 

State:                    Zip Code:                                Country:

Telephone:  Home:       Cell Phone:       Work: 

E-Mail:                   Contact Preference   All Provided Methods Home Phone Cell Phone Work Phone E-mail

Presently working with realtor:   No Yes                 Reasons for selling/buying:  Select Need larger home Downsizing Job related move Location Other
 

Buyers Information

Subdivision or Area of House:                   

Sq. Ft.  (approx.):                                      Lot Size:     

Bedrooms:        Select One Two Three Four Five More than 5                     Bathrooms:    Select One 1.5 Two 2.5 Three 3.5 4 or More