Your Name: Your Phone Number: If you can receive information by fax, what is the fax number: (Please include area code) Mailing address: Street Address City State Zip What is your email address: What school district do you prefer to be located in (if any): Do you own a home now or are you renting: Renting Own choose one How many family members will be living in your new home: How soon would you like to move into your new home: What style of home do you prefer: choose one Ranch (1 story) Cape Cod (1-1/2 story) 2 Story Bi-level Raised Ranch Split Level Earth Home Condo Duplex Mobile Home Double Wide Modular or Manufactured Other Minimum number of bedrooms you will need: choose one 1 Bedroom 2 Bedrooms 3 Bedrooms 4 Bedrooms 5 Bedrooms 6 Bedrooms More than 6 bedrooms How many baths will you need: choose one 1 Bath 1-1/2 Bath 2 Bath 2-1/2 Bath 3 Bath 3-1/2 Bath 4 Bath 4-1/2 Bath 5 Bath 5-1/2 Bath 6 or more baths What type of garage do you prefer: 1 car garage 1-1/2 car garage 2 car garage 2-1/2 car garage 3 car garage 3-1/2 car garage 4 or more car garage Pole Barn / Garage Attached Detached Combination Other None Have you been preapproved for a home loan yet: Yes No choose one Do you have a specific bank or mortgage company that you would like to work with: Yes No choose one Did you know that I can get today's interest rate locked in for approximately 30 days to protect you against future rate increases? Would you like for us to lock in the rate for you: Yes No choose one Please tell me about any special features that are important to you: What is the best time for you to view homes: or