| Your Name |
|
| Work Phone |
|
| Home Phone |
|
| E-mail |
|
Address
(Optional) |
|
| City |
|
| State/Zip |
Zip
|
| Income (est.) |
|
Are you interested in buying
real estate or insurance |
Interested in
buying real estate
Interested
in buying or revising insurance policy
Interested in both real
estate and insurance |
Are you thinking of selling
your home? |
Yes, I am
thinking of selling my home
No, I do not
plan to sell my home at this time |
What type of property
are you looking for? |
|
 | If buying a home... |
|
|
| Preferred price range |
|
| Preferred square footage |
|
| Bedrooms |
|
| Bathrooms |
|
| Garage |
|
| Acres |
|
| Levels |
|
| Additional Comments |
|
