Full Name:

Email Address:

Home Phone:

Work Phone:

Cell Phone:

Address:

Postal Code:

What part of town are you looking to own in?

How many bedrooms do you need?

How many bathrooms do you need?

How many people will be living in your home?

Adults?

Teens?

Children?

What else is important to you in your home? (Garage, Deck, etc...)

How long at present address? Pick One 0 to 6 months 6 months to 1 yr 1 to 3 yrs 3 to 5 yrs Over 5 yrs

When does your present lease expire?

When do you have to move?

Why are you moving?

Names and numbers of present and previous landlords (if any):

How much is your present rent or mortgage?

What is the maximum monthly payment you can afford?