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Contact Information
Name
Phone Number
Email Address
Best Time to Contact	Morning Afternoon Evening
Home Search Information
Cities you would like to live in? (Please List ALL Cities)
Price range?
Square footage?
Bedrooms?
Bathrooms?
Garage?	2 car 3 car 4 car don't care
Built On?	Basement slab crawl don't care
Other Preferences (Please Specify...)
When to purchase	Immediatly Within 2 Months Within 6 Months Within 1 Year Undecided
Do you need to sell your present home?	Yes No
Would you like to get 3 banks to compete for your business?	Yes No
Are You working with another Realtor?	Yes No
Personalized List
Enter your complete mailing address if you would like me to mail you a personalized list of homes or properties in your range.
How did you find Web site?	Newspaper Friend Mailer Web-Search Other