First Name:
Last Name:
Email Address:
Have you ever owned a home before?:
Have you been through a bankruptcy
or foreclosure?:
What part of town are you looking to own in?:
How many bedrooms do you need?:
How many bathrooms do you need?:
How many people will be living in your home, including everybody?:
Adults:
Teens:
Children:
What ammenities do you require?:
Garage Shed Deck FencedYard Mall School
What else may be important
to you in your home?:
When does your present lease expire?:
Will you be giving your landlord 1 month notice?:
When do you have to move?:
What are the names and phone numbers of your
present landlord and (Last 5 years)
Landlord 1
Landlord 2
Landlord 3
How much is your present rent per month?
What does your present rent include?
Water Electricity Gas Cable Telephone
How much could you afford monthly
if you were going to own a home?:
How long have you been at
your present address?:
What is your combined annual
gross household income?:
How much do you have for a down
payment on your new home?:
What is your current address?:
Contact Phone Numbers Daytime:
Work:
Cellular:
Evening:
Home:
What is the best time of day to reach you?:
Company contact name: