Amy's Information Request Form	For All Your Real Estate Needs

INTERESTED IN BUYING?

A place to fill out information, so I can promptly and accurately provide
   detailed information based on your specific needs.

Name:

Co-Owner:

Street Address:

City:    State:    Zip Code:

E-mail Address:

Home Phone (with area code):

Secondary Phone (with area code):

The Best Way To Contact You: EMAIL PHONE

Do You Have a House to Sell? Yes | No |

Is You House Currently For Sale? Yes | No | N/A

Price Range of New House: BELOW $100,000 $100,000 - $120,000 $120,000 - $150,000 $150,000 - $200,000 $200,000 - $250,000 $250,000 - $300,000 $300,000 - $350,000 $350,000 - $400,000 $400,000 - $500,000 $500,000 OR MORE

Number of Bedrooms: TWO THREE FOUR FIVE OR MORE NONE - LAND

Desidered Location: SUBDIVISION GOLFCOURSE CITY, CLOSE IN COUNTY - ACREAGE

Age: NEW 1 - 5 YEARS 6 - 10 YEARS 10 - 15 YEARS 15 - 30 YEARS 30 YEARS OR MORE

Do You Need to Sell in Order to Buy? YES NO

How Quickly Will You Sell? IMMEDIATE TO 30 DAYS 30 - 90 DAYS 90 - 120 DAYS 120 -180 DAYS 180 - 360 DAYS 1 YEAR OR MORE

How Did You Locate our Website? SIGN FRIEND/REFERRAL REALTOR.COM NATIONAL MAGAZINE SEARCH ENGINE VOICE MAIL BUSINESS CARD OTHER ADVERTISEMENT OTHER LINK HOMES AND LAND OTHER

Additional Comments: