*Name:

Address:

*City:

*State:

*Home phone:

*Work phone:

Cell phone:

Pager:

Fax:

*When is the best time to reach you?

Agent/Pre-Qualification Info

*Do you currently have an agent? Yes No

If yes, who?

*Are you a first time buyer? Yes No

*Are you currently a homeowner? Yes No

If yes, what area?

*Are you Pre Approved? Yes No

If yes, with whom?

*How much are you pre approved for?

*Loan Officer Name:

House Info

*Are you interested in a specific house? Yes No

If yes, which one?

*What area are you interested in?

What type of house are you interested in?

*What is your price range?

*What amount of square feet do you want?

*What number of bedrooms do you want?

*What number of bathrooms do you want?

Do you want a garage? Yes No

*What lot size do you want?

*What age would you prefer?

Comments:

Anything you want to tell me that isn't on this form? Feel free to comment here or email me!