Style of Home Preferred

Rambler  Contemporary 

Two Story  Tudor 

1.5 Story  Colonial 

Multi-Level Split-Entry 

Other: 

Features:

Number of bedrooms: 

Number of Bathrooms: 

Formal Dining Room 

Eat-In Kitchen 

Family Room 

Porch  Deck Sunroom 

Basement: Finished Unfinished  Walkout 

Total Square Feet (approx. range) 
 
Garage: 


1 Car
2 Car
3 Car or More



Attached
Detached

Special
Features:

Fireplace Master Bath 

Large Kitchen On a Lake 

Gourmet Kitchen Mother-In-Law Apartment 

Other:

Yard Size:

City Lot 

Suburb Lot 

Other: 

Price Range:

Under 100,000
100,000-200,000
200,000-300,000
Over 300,000

Loan Information

Do you own your own home now?     Yes No

Are you eligible for a VA loan?     Yes No

Type of loan desired?

Will you require a mortgage?     Yes No

Max amount you want to invest as a down payment. 

Have a loan officer contact me?     Yes No

Personal
Information:

Your Name 
Street Address 
City 
State/Province 
Zip/Postal Code 
Telephone Number 
Pager/Secondary Number
FAX Number 
Email Address 

Any Special Requirements

Thank You!

Before submitting this form, please be sure you have filled out all of the 
necessary information I will need to contact you!