Name  

Current Address  
   

Email Address

Home Phone

Business Phone (if applicable)           Extension (if applicable)
                            

NEW HOME INFORMATION

    New Community

Business Address (if applicable)
 

City

State

Phone                          Extension: 
         

Commute
Yes     No

Time

Miles

Auto     Train     Bus

Other

    New Home Preferences

Age:    1 to 5 years     6 to 10 years     Older Home

Style:    Contemporary     Ranch     Colonial    
Split-Level     Cape Cod    
Other

Development:    Townhouse     Condo    
Senior Development     Gated Community
Other

Construction:    Brick     Frame
Other

Land:     Subdivision    
Acreage
Other

Rooms:    # of Bedrooms    
# of Full Baths     # of Half Baths
Other

Additional Rooms:    Living Room     Family Room    
Library/Study     Recreation     Formal Dining    
Dining Area     Breakfast Area/Nook     Wet Bar
Other

Basement:    Yes     No

Garage:    Attached     Detached    
# of Autos

Price Range:    $ to $

Initial Investment Range:   
$ to $

Monthly Payment Range:   
$ to $

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