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Your Information

Your Full Name:                                     Home Phone Number                                         

Street Address                                         Work Phone Number                

City, State, Zip                                      Cellular Phone (optional)                              

Email Address                                         Fax Number  (optional)                                                  

How did you find out about us?                                                                

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Questions:

How soon would you like to move?                   Number of stories                                                                                                        

Desired age of home?                   What price range are you considering?                                   to

Minimum square footage          Would you like a pool?                                                                     yes No

Number of bedrooms?         Number of bathrooms?                                                                                         

Number of Garages

Are you currently working with a Real Estate agent?

What is the best time to call you?

Desired Features:

                    

   

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