Name
Email Address
Mailing Address
Home Phone (Please Include all International Calling Codes)
Best time to call at home
Work Phone (Please include all International Calling Codes)
Best time to call at work
Area Desired
Ft. Myers / Naples Area
Ft. Lauderdale / Miami Area
Jacksonville Area
Key West Area
Orlando
Orlando Area
Pensacola Area
Sarasota / Brandenton Area
Space Coast
Tampa Bay Area
Other (Complete field below)
Complete for Area Desired if not listed above
When do you need your new home?
When Current Home Sells
Immediately
1 Month
2 Months
3 Months
4 to 6 Months
6 to 8 Months
9 to 12 Months
More Than 12 Months
Are you currentlly working with a Realtor to buy a property?
Yes
No
Price Range Desired
Less Than $100,000
$100,000 to $150,000
$150,000 to $200,000
$200,000 to $250,000
$250,000 to $300,000
Over $300,000
Not Buying - Interested in Renting
Type of Property Desired
Single Family
Duplex
Townhouse / Condominium
Apartment
Commerical Property
Other
When do you plan to sell your current home?
Currently Renting
Buying Additional Home
Immediately
1 Month
2 Months
3 Months
4 to 6 Months
6 to 8 Months
9 to 12 Months
More Than 12 Months
Is your current home listed with a Realtor?
Yes
No
May we contact you concerning listing your current home?
Yes
No
Is your relocation employment related?
Yes
No
If employment related, name of employer
Driving distance from employment desired
Please Choose Distance
5 miles or less
10 miles or less
15 miles or less
20 miles or less
25 miles or less
50 miles or less
What are you financing requirements?
Mortgage Not Needed
Please Have Lender Contact Me
Pre-Qualified
Pre-Approved
In Process
VA Loan
Additional Comments
