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Name: Address: City: State: Zip: Home Number: Work Number: Email Address: What Localities, City, and State are you interested in moving to? Number of Children: Age of Children: Would you like school information? Yes No Approximate Move Date: Immediately 1 - 3 months 3 - 6 months 6 - 9 months 9 - 12 months 12 - 24 months Over 24 months Upon sale of current home Undecided Do you currently own a home? Yes No If yes, what do you own? House Condo Townhome What do you plan to buy? House Condo Townhome What is the Price Range of your dream home? 1MM + 750K - 1MM 500K - 750K 400K - 500K 325K - 400K 250K - 325K 175K - 250K 125K - 175K Under 125K What is your current household income? 300K + 200K - 300K 100K - 200K 75K - 100K 50K - 75K 25K - 50K Under 25K Have you been pre-approved by a mortgage lender? Yes No Comments/Ideas: