First Name

Last Name

Property Address

City

State, Zip

Home phone

Primary Residence or other (choose one)

Primary Residence Rental Home

Relationship with Property (choose one)

Legal owner Renter Landlord Property Manager Potential Buyer Other

Type of Property (choose one)

Single Family Multiple Family Townhouse Condominium Manufactured Home Mobile Home

Style of Home (single story, ranch style, split level, etc.)

Approximate Year Built

Number of bedrooms

Number of full bathrooms

Number of half bathrooms

Number of fireplaces

Approximate Square footage

Lot Size / Acreage (choose one)

City Lot 1/2 Acre 1 Acre 2 to 5 acres 6 to 10 acres 10+ acres unsure

Heat Type

Air Conditioning Type

Central Air Window Unit Central and Window None

Basement

Yes : No

Basement type (choose one)

None Walkout English Garden

Pool

Yes

Parking

Yes : No

Parking number of cars

None 1 car 2 cars 3 cars More than 3

Rate Overall Condition (choose one)

1 Poor 2 3 4 5 Excellent

Sub Division Name

Model Name

Additional Comments

When are you planning to sell?

Right Away 90 days 6 months 12 months

Where will you be moving to?

Is your home currently listed?

Yes - with an Agent For Sale By Owner Not Currently Listed

Thank You

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