First Name:            Last Name:         

                 Email:                   Phone:          

  Relocation City:            State:      

  When do you plan on moving? 1-3 Months 3-6 Months 6 Months - 1 Year 1 Year 1+ Years

  Do you need to sell another house first? Yes No

     Type of Home: Single Family Home Recreational Mobile Home Land Multi-Family Home      

        Price Range: Under $70,000 $70,000-$110,000 $110,000-$150,000 $150,000-$200,000 $200,000-$300,000 $300,000 & Above   Have you been pre-approved?  Yes No

        Square Feet Range: Under 1,000 1,000-1,500 1,500-2,000 2,000-2,500 2,500+    Acres of Land:

            Bedrooms: 1 2 3 4 5+     Bathrooms: 1 1.5 2 2.5 3 3.5 4 4.5 5 5+     Garage: None 1 Car 2 Car 3 Car

            Preferred Amenities:

          Comments/Questions:

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