Your Name                          Spouse's Name
       
Telephone                           Telephone
       
Age                                      Age
       

Current Address

Address 2

City                                       State        Zip Code
                   

When are you planning on buying a home?
Now 3 Months 6 Months 1 Year

What is your approximate household income?
Under $18,000 $18,000-$27,000 $27,000-$36,000 $36,000-$45,000 $45,000-$54,000 $54,000-$63,000 $63,000-$72,000 $72,000-$81,000 $81,000 and above

What is the maximum monthly payment you feel comfortable with?

Are you a US Veteran?
No Yes

What type of home are you interested in buying?
Single Family House Comdominium Townhouse

What is your price range?

What Real Estate area are you interested in?

Describe to us the type of home and features you are looking for:
Bedrooms               Full Bath(s)       Half Bath(s)      Car Garage        Fireplace
2 3 4 More than 4          1 2 3 More than 3    1 More than 3 2 3    None 1 2 3 More than 3      Yes No Maybe

Living Room           Dining Room    Den                    Central Air          Heating
Yes No Maybe                 Yes No Maybe           Yes No Maybe           Yes No Maybe            Heat Pump Gas Either

Deck                        Porch                Patio
Yes No Maybe                 Yes No Maybe          Yes No Maybe

Type of construction (i.e., ranch, 2 story)

Square Feet

Exterior Construction (i.e., brick, vinyl)

Other Interior Features                                   Other Exterior Features
                            

Comments or Questions