Address:

City: State: Zip:

Home Number:

Work Number:

Email Address:
(AOL members please include @aol.com after your screen name)

What Localities, City, and State are you interested in moving to?

Number of Children: Age of Children:

Would you like school information?

Yes

No

Approximate Move Date:

	Immediately		1 - 3 months		3 - 6 months
	6 - 9 months		9 - 12 months		12 - 24 months
	Over 24 months		Upon sale of current home		Undecided

Do you currently own a home?

Yes

No

If yes, what do you own?

House

Condo

Townhome

What do you plan to buy?

House

Condo

Townhome

What is the Price Range of your dream home?

	1MM +		750K - 1MM		500K - 750K
	400K - 500K		325K - 400K		250K - 325K
	175K - 250K		125K - 175K		Under 125K

What is your current household income?

	300K +		200K - 300K		100K - 200K
	75K - 100K		50K - 75K		25K - 50K
	Under 25K

Have you been pre-approved by a mortgage lender?

Yes

No