Name
Address E-mail Tel(Res)
Tel(Bus) Fax
Do you presently own a home? Yes No
If YES, what style is it? (eg. - 1 storey, 2 storey, Cape Cod, Condo, Apartment, etc.)
Would you be looking for a similar style home? Yes No
How many members are in your family? Number of Children
Will you be looking for a home in the City Country
Please indicate the features you would like to have in a home
Number of Bedrooms Number of Bathrooms
Separate Dining Room Yes No Family Room Yes No
Fireplace Yes No Garage Single Double
Are there any other features that you would like to have in a home?
In what price range will you be looking?
What type of schools will you require? (Private/Public/Other)
What amenities would you like to have in your neighborhood?
Where will you be employed?
Are you familiar with your new city? Yes No
Will you require mortgage financing for your purchase? Yes No
