Date

Name

Address

Email Address

Telephone Number (Business)

Telephone Number (Residential)

Type of Home Required

No. of Rooms

No. of Bathrooms

No. of Bedrooms

Fireplace

Family Room

Basement

Extras

Location Preferred

School Requirements

When possession required

Own home or renting?

If so, must sell before buying?

Intent to buy using full equity?

Amount of Down Payment

Interested in Trading

Reason for buying

Price range

Employer

How Long

No. in family working

Husband's income

Total income

TOTAL INVESTMENT

INITIAL INVESTMENT

MONTHLY INVESTMENT

Houses Shown

Address

Price

What other houses have they seen

Comments

Source of Contact