Please provide the following Contact and Other information:

	Contact Info                                           Your Address
First Name*	Street
Last Name*	City
Work Phone	xxx-xxx-xxxx     State
Home Phone*	xxx-xxx-xxxx     Zip
E-mail*	County
	Your Property Needs
Type of Home	Single Family Home Town House Condo Multi Family Other Mobil Home # Bedrooms 1 2 3 4 5+ Baths 1 2 3 4+ 1/2 Bath 0 1 2
Sq. Ft.	500-1000 1000-1500 1500-2000 2000-2500 2500-3000 3500+    Home Age 1-3 Years 3-5 Years 5-7 Years 7-10 Years 10-15 Years 15-20 Years 20-25 Years 25-30 Years Older House is Ok   Garage 1 2 3 Carport No Garage No Carport
Home Condition	Needs Work Needs Lot of Work Very Good Good Fair Excellent               Pool Yes No   Water Front Yes No
Construction	Block Brick Frame Other   Floors   1 2   # of Trees 0 1 2 3   Tree Sizes Small Medium Big Large
Occupied	Yes No   If Not Occupied   Vacant Rented   If Rented (How much Rent)
	Finance Info
What kind of Buy/Rent Program are you looking for? Rent Rent-to-Own Buy with Bank Financing Buy with Owner Financing Wholesale Any of the Above
What is the most you can afford to pay monthly?    300-500 500 550 600 650 700 750 800 850 900 950 1000 1050 1100 1150 1200 1250 1300 1350 1400 1450 1500 1550 1600 1650 1700 1750 1800 1850 1900 1950 2000+
Most you can afford to put down on your home?     2000-3000 3000-4000 4000-5000 5000-6000 6000-7000 7000-8000 8000-9000 9000-10000 10000-11000 11000-12000 12000-13000 13000-14000 14000-15000 50000+
Do you have any retirement account with your employer?  Yes No N/A
How is your credit?  Excellent Good Fair Not so good Poor No Credit
How soon you are looking to purchase?   ASAP 1-2 Months 2-4 Months 4-6 Months 6-8 Months 8-10 Months 10-12 Months
	Please Note your information is100% CONFIDENTIAL