First name:
                                    Last name:

                                    Are you the owner of this home or other property: Yes No     If NO, please fill in sellers name below

                                    First Name:
                                    Last Name:

                                    Sale property address:
                                    City:     St:   Zip:

                                    Daytime phone:
                                    Evening phone:
                                    Telephone contact permission: Yes No

                                    Email:

                                    When will you be ready to sell: Now Next week Next month In 3 months 6 months or more
                                    Will you be purchasing a new home: Yes No Not sure

Details of your home or other property

                                    Sq footage:     Bedrooms: 1 2 3 4 5 6 7 8     Baths: 1 1.5 2 2.5 3 3.5 4 5 6.5     Garage: 0 1 2 3 4

                                    Lanai: No Yes     Pool: No Yes     Screen room: No Yes

                                    Give a brief description of your home or other property: