* Name:
* Address:
* City, State, Zip:
Address of house to sell (if different):
City, State, Zip:

* Email:
* Home phone:
Work Phone:
* Best time to call:
Do you have an agent? Yes No

* Number of Bedrooms:
* Number of Bathrooms (full/half)
Garage Spaces No garage Carport One Two Three or more
Basement (hold the shift key to choose more than one description) None Cellar Partial Full Walk-out Finished

Recent improvements and/or renovations made to the house (please note when they were made)

Features of your home that might make it different from your neighbors' houses

When are you planning to put your house on the market?
Now 1-3 Months 3-6 Months More than 6 Months Unsure
Is your home already on the market or do you have a listing contract? Yes No

If I have questions I'll telephone you, so please be sure to include a good phone number above. I look forward to speaking with you!