| Your first and last name: |
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| Current Address: |
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| City, State: |
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| Zip code: |
(i.e. 99999) |
| Home phone: |
(i.e. 999-999-9999) |
| Work phone: |
(i.e. 999-999-9999 or NA) |
| Cell phone/Pager/Msg #: |
(i.e. 999-999-9999) |
| Gross monthly household income: |
(Enter only numbers i.e. 100000) |
| Maximum down payment: |
(Enter only numbers i.e. 100000 or NA) |
| Maximum monthly payment: |
(Enter only numbers, e.g. 100000 or NA) |
| When would you like to move: |
(Enter future date, MM/DD/YY) |
Minimum Bedrooms
/ Baths: |
(e.g. 3 / 1.5) |
| Minimum Square Feet: |
(Enter only numbers, e.g. 1000) |
| Is a garage mandatory? |
yes no |
| Price Range: |
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| Location Preferences: |
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| Best time to contact you: |
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| Email address: |
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| Current Credit Rating: |
Excellent Good Fair Poor |
Concerns or Conditions:
|
(e.g. Credit disclosure/explanation, special requirements) |
| Where did you hear about us: |
|
