*First Name       

*Last Name       

*Address           

*City                 

*Province           BC AB SK MB ON

*Postal             

*Day Phone      

*Evening Phone

Cell/Pager        

*Best Time to Reach You    Anytime Morning Afternoon Evening Night

*Email             

Your Property Needs

*What's the most you can afford to pay monthly for your new home?     $250 $300 $350 $400 $450 $500 $550 $600 $650 $700 $750 $800 $850 $900 $950 $1,000 $1,100 $1,200 $1,300 $1,400 $1,500 $1,600 $1,700 $1,800 $1,900 $2,000 $2,250 $2,500 $2,750 $3,000 $3,250 $3,500 $3,750 $4,000 $4,250 $4,500 $4,750 $5,000+

*What's the most you can you afford to put down on your home?          $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 $4,500 $5,000 $5,500 $6,000 $6,500 $7,000 $7,500 $8,000 $8,500 $9,000 $9,500 $10,000 $12,500 $15,000 $17,500 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000+

*What price range house are you looking for?    $1,000 $5,000 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $450,000 $475,000 $500,000 $550,000 $600,000 $650,000 $700,000 $750,000 $800,000 $850,000 $900,000 $950,000 to $5,000 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $450,000 $475,000 $500,000 $550,000 $600,000 $650,000 $700,000 $750,000 $800,000 $850,000 $900,000 $950,000 $1,000,000

*How is your credit? Ugly is OK!    Excellent Good Fair Poor Ugly No Credit

*How soon are you looking to purchase your next home?    ASAP 1 month 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 12 months +

*In which area(s) do you wish to purchase your home?      

*How many bedrooms do you require?     Any 1 or more 2 or more 3 or more 4 or more 5 or more

*How many bathrooms do you require?    Any 1 or more 2 or more 3 or more 4 or more 5 or more

*How many square feet do you require?   500 sq ft or more 600 sq ft or more 700 sq ft or more 800 sq ft or more 900 sq ft or more 1000 sq ft or more 1250 sq ft or more 1500 sq ft or more 1750 sq ft or more 2000 sq ft or more 2250 sq ft or more 2500 sq ft or more 2750 sq ft or more 3000 sq ft or more 3250 sq ft or more 3500 sq ft or more 3750 sq ft or more 4000 sq ft or more

*Do you require a garage?     Yes No

*Do you require a basement? Yes No

Do you have any other special requirements?   

Do you have any additional questions or comments?     

*How did you hear about us?