Full Name:

Address:

Home Phone:

Cell Phone:

Email Address:

Have you ever bought or sold a home in the past?YesNo

Do you need to sell a property before you can purchase another?YesNo

Are you currently in a lease?YesNo

How soon do you need/want to be in a new home?

Are you interested in resale home, new home, or both?

Do you or any members of your family have any disabilities, conditions, or other
circumstances that would require specific home features? YesNo

What price range have you been considering?

In what area, zip code, or city do you want to buy the property?

What type of property do you prefer?Single family homecondotownhouse

Does the house have to have a pool?YesNo

Water front property?YesNo

Minimum water frontage?

How many bedrooms do you need?

How many bathrooms do you need?

What square footage do you prefer?

Do you need a garage?

Any additional requirement, please list here:

Have you arranged financing yet?YesNo

Do you need assistance in locating a lender?YesNo

Have you been pre-qualified or pre-approved?YesNo

Please provide your lender’s name and contact info?