Client Information Page

This is an explanation of the purpose of the form ...

Please provide the following contact information:

Name

Organization

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Work Phone

Home Phone

FAX

E-mail

URL

Which of the following are you interested in?:

Buying
Selling
Renting

Please let me know the type of home you are interested in:

Single Family Detached
Townhome
Condo
Apartment

When will you be moving?:

1-3 months
3-6 months
6-12 months
1 year+

Do you Own or Rent:

Own
Rent

Are you currently working with an Realtor?:

Yes
No

Are You pre-qualified for a Loan?:

Yes
No
No, please have a loan officer contact me

Approximate Square Footage of next home:

Under 1,000 sq.ft.
1,000-1,500 sq.ft.
1,500-2,000 sq.ft.
2,000-2,500 sq.ft.
2,500-3,000 sq.ft.
3,000-3,500 sq.ft.
3,500-4,000 sq.ft.
above 4,000 sq.ft.

Price Range you are looking for:

Would you like a relocation package sent to you?:

Yes
No

Please indicate information about your family:

How Many Children?   Ages?

Income Range:

$20,000- $40,000
$40,000- $50,000
$50,000- $60,000
$60,000- $75,000
$75,000- $90,000
Above $90,000

Name
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Client Information Page

Copyright Ed Haraway 1997 Last revised: December 14, 1997

Copyright Ed Haraway 1997
Last revised: December 14, 1997