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First Name
Last Name
Address
Zip
City
State
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AK
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AR
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CT
DE
DC
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GA
HI
ID
IL
IN
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VA
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Phone
E-mail
Relationship to property
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Current Owner
Tenant
Potential Buyer
Other
Property type
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Single Home
Condo/Town home
2-4 Units
5+ Apartments
Approximate year built
Bedroom Count
Approximate square footage:
(Not Including Garage)
Full bathroom count (those with a tub)
3
/
4
bathroom count (those with shower but no tub)
1
/
2
Bathroom count (those with sink and toilet only)
Fireplace count
Lot size
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5000-10000 square feet
10000-22000 square feet
1/2 acreTo 1 acre
To 1 acre - Over 1 acre
Heating type
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Forced Air
Wall Furnace
Other
Air conditioning type
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Central a/c
Wall/Window Unit
None
Pool?
Yes
No
Garage space count
Rate the condition
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1 Major fixer
2
3
4
5
6
7
8
9
10 Excellent
Other comments or amenities
(please elaborate, it will help during the evaluation)
When do you intend to sell
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Now
1-3 months
3-6 Months
Longer
Where are you planning to move?
Is your home presently listed for sale with a Realtor?
Yes
No
How did you hear about {Site}?
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Newspaper
Radio
TV
Other
Comments
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