DATE:______________________________________________________________

CURRENT ADDRESS:_________________________________________________

TELEPHONE #:_______________________________________________________

E-MAIL ADDRESS:____________________________________________________

PRICE____________________ RANGE:_______________________________________________________

NUMBER OF BEDROOMS NEEDED:_____________________BATHS:__________

NUMBER OF PEOPLE THAT ARE GOING TO LIVE AT ADDRESS:______________

DO YOU CURRENTLY HAVE A FULL TIME JOB? YES____________ NO_________

WHAT IS YOUR MONTHLY INCOME?_____________________________________

DO YOU HAVE ADDITIONAL INCOME?___________________________________

CREDIT RATINGS? GOOD______ FAIR _______ AVERAGE_______ POOR_______

IS IT OKAY TO CONTACT YOU VIA E-MAIL ABOUT HOUSES THAT WE HAVE FOR SELL?_____________________________________________________________

HAVE YOU OWN A HOUSE IN THE PAST 3 YEARS?__________________________

HOW SOON DO YOU WANT TO MOVE IN?__________________________________

COMMENTS:_________________________________________________________