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Address:

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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
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

Other Important Interior Features:

Exterior Features & Preferences

Other Important Exterior Features:

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.

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