Please tell us a little about yourself:

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Home Phone
FAX
*E-mail	Required

• When were you planning your move to our area?

Immediately
Within 6 months
Within 1 year
Don't Know


• Were you interested in condominiums or a single family dwelling?

Condominium only
Single-family only
Either one would be fine

• What sort of price range are you looking for?

Under $100K
$100K to $200K
$200K to $300K
over $300K

• Were you looking to rent or purchase your home?

Rental
Purchase


• What sort of location? (choose all that apply):

Waterfront (bay or gulf)
Waterfront (bay only)
Waterfront (gulf only)
Land-locked
Golf Course


• How many bedrooms are you interested in having? (choose all that apply):

One           Two           Three         Four        
Five or more  

• How many bathrooms? (One choice only):

One - Two
Two - four
More than four


• Do you need an enclosed garage area?

Yes
No
Does not Matter


• Would you like a sales representative to contact you?

Please do not call.
Please call me.

Please call me at:  


Do you have any special requests?