Name:

Street Address:  

City, State, Zip

Email Address:

Home Phone:               Business Phone:
         

Do you want me to call, and if so when is the best time:
yes  morning afternoon  evening no, just use email   

Do you currently:     own a home        rent a home or apt.

When do you anticipate a move to the area?
immediately   30 days   3 months  6 months or longer

Price range of home you wish to purchase:

Desired area you wish to live:
South Bend Mishawaka Granger Elkhart Not Sure

Do you need assistance with a Mortgage Lender? yes no

Desired Style of home: Ranch  Two-Story  Tri-level    Bi-level  no preference Basement is necessity

Do you need a garage? 1 car 2 car 3+ carnot necessary

How many bedrooms:   2 3 4 5+  How many bathrooms:  1 1.5 2 2.5 3+

Here is a list and description of amenities I really want in my neighborhood and home:

Thank you so much for taking the time to fill out this form.  I will contact you by email or phone (if you prefer) within 24 hours.