* REQUIRED FIELDS

Your Name (First, Last):	*
Address of Property:	*
City:	*
State:	*
Zip:
Home Phone:	*
E-Mail:	*
Neighborhood Name:
Type of Property:	Single Family Home Multiple Family Home Townhouse Condominium Manufactured Home Mobile Home
Style of Home (single story, ranch style, split level, etc):
Approximate Year Built:	*
# of Bedrooms:	*
# of Full Bathrooms:	*
# of Half Bathrooms:
# of Fireplaces:
Approximate Square Footage (Garage and Basement excluded):	*
Lot Size / Acreage:	City Lot 1/2 Acre 1 Acre 2-5 Acres 5-10 Acres 10+ Acres Unsure *
Heat Type:
Air Conditioning :	Yes No
Pool :	Yes No
Overall Condition :	excellent good avg poor *
Additional Comments(Describe special features i.e. ocean front, tile roof, front, brick exterior, etc.):
When are you planning to sell?	0-3 months 4-6 month 7-9 months 10-12 months *
Are you planning on purchasing another home within 12 months:	Yes No