1. First Name
2. Last Name
3. Spouse/Partner First Name
4. Spouse/Partner Last Name
5. Current Address
6. City
7. State Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
8. Zip
9. Day Phone Number
10. Evening Phone Number
11. Alternate Phone Number
12. Best Phone to Call Day Phone Evening Phone Alternate Phone
13. Best Time to Call You Select... 9:00 am - 12:00 noon 12:00 noon - 5:00pm 5:00pm - 9:00pm
14. Email Address
15. Relocating to what ZONE? (City/County/Area/Neighborhood)
16. State You Are Moving To Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
17. Expected Date of Your Move? Select... Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Select... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select... 2006 2007 2008 2009 2010
18. Scheduled Date to Visit the Area? Select... Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Select... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select... 2006 2007 2008 2009 2010
19. Additional Information (Such as County, Desired Neighboroods, Schools etc.)
20. Estimated Sales Price Range?
21. Type of Property You Are Selling? Single Family Residence Townhome Condo
22. Number of Bedrooms 1 2 3 4 5 6 7 8 9 10
23. Number of Bathrooms 1 2 3 4 5 6 7 8 9 10
24. Square Footage of Your Home
25. Lot Size?
26. Do You Have a Pool or Spa? None Pool Spa Both
27. Garage/Parking for (min # of Vehicles)
28. Do You Have a Fireplace? (#/Location) (min # of Vehicles)
29. Any Lot Amenities?
30. Any inside Amenities?
31. Recent Improvements?
32. Do You Need to Sell Your Current Home(s)/Property First? Yes, I need to sell first No, I don't need to sell first
33. When do You Plan to Put Your Home on the Market?
34 Where Did You Hear About Us?
35. Any Other Comments?
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