EMail Address
Name
Address
City, State
Zip
Telephone
How Long
Looking for a home
30 Days or Less
30-60 Days
60-90 Days
90+Days
Working with another
agent?
No
Yes
If Yes, Whom?
Number in Family
1
2
3
4
5 or Over
Presently
buying or renting
Buying
Renting
If own,
do you have to sell?
Yes
No
Estimated
Value of home
Under $100,000
$100,000-$150,000
$150,000-$200,000
$200,000-$250,000
$250,000-$300,000
$300,000-$400,000
$400,000-$500,000
$500,000-$600,000
$600,000-$700,000
Over $700,000
Your Price Range
Less than $100,000
$100,000-$150,000
$150,000-$200,000
$200,000-$250,000
$250,000-$300,000
$300,000-$350,000
$350,000-$400,000
$400,000-$500,000
$500,000-$600,000
$600,000-$700,000
$700,000-$800,000
$800,000-$900,000
$1,000,000 and Over
Number
of bedrooms needed
2
3
4
5+
Number of bathrooms
needed
2
3
4
5+
Living
Square Feet needed
1500-2000
2000-2500
2500-3000
3000-3500
3500-4000
4000-4500
5000 & Over
