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Application Name Home Phone Work Phone Best Time FAX Plan to Buy 30 60 90 Days Price Range Need Financing YES NO No Down, Interest only etc. Down Payment 0%, 5%, 10%, 15% or 20% of price Closing Cost 3% of price Desired Location Property Type Square Footage Lot Square Footage Total Number of Rooms 5 6 7 8 9 10 Bed Rooms 2 3 4 5 6 Bath Rooms 1 1.5 2 2.5 3 3.5 4 Fireplace 1 2 3 Garage 1 car 2 car 3 car Home Warranty Insurance YES NO Energy Efficient YES NO Air Conditioning YES NO Landscaped YES NO Pool Spa YES NO Near Schools YES NO Day Care YES NO Religious Services YES NO Shopping Malls YES NO Restaurants YES NO Fast Foods YES NO Entertainment YES NO Libraries YES NO Transportation YES NO Sport Activities YES NO Other Explain Email your estimated Monthly Payments YES NO Keep you posted on new listings YES NO
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