Client Information Form

Client Information Form

Let us get to know you and your needs
Personal Information

We just want the basics.
Primary Contact
First Name*
Last Name*
Age*

18-2425-3435-4445-5455-6465+
Primary Contact Phone*
Please enter a valid phone number.
Primary Contact Email*
example@example.com
Primary Contact Place of Business
Total Family Income

30K-50K60K-80K90K-110K120K-150K160K-200K210K+
Primary Contact Current Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to add a Secondary Contact?

Yes!No, Thank you!
Secondary Contact
First Name
Last Name
Age

18-2425-3435-4445-5455-6465+
Secondary Contact Phone
Please enter a valid phone number.
Secondary Contact Email
example@example.com
What is the purpose for your new home?*

Primary HomeSecondary HomeRental Property
Do you currently own a home?*

YesNo
Will you be selling your home?*

YesNoI'm not sure
Do you have a Realtor?*

YesNo
Who is your Realtor?*
New Home Information

What are you looking for?
What is the square footage you are looking for?*

Under 1000 sq. ft.1001 sq. ft. - 1500 sq. ft.1501 sq. ft. - 2000 sq. ft.2001 sq. ft. - 2500 sq. ft.2500 sq. ft. - 3000 sq. ft.Above 3000 sq. ft.
How many bedrooms are you wanting?*

12345 or above
How many bathrooms are you wanting?*

12345 or above
Do you prefer a garage or a carport?*

GarageCarportBothOther
Do you have any other storage needs? i.e. Four Wheelers, Boat, Side by Side, etc.*

YesNo
What are your other storage needs?*
Financial Information

Let's get a plan together!
How will you be financing your home?*

CashConventional LoanFHA LoanVA LoanOther
We have a lender that has been with us from the beginning. We'd love to connect you with them!
What is your budget?*
This amount won't lock you in. This is just to get an idea.
Do you have land you would like to build on, or would you like to see what land we have to offer?*

I have my own land to build on.I'd like to see what Hayhurst Brothers has to offer!
Whether you're looking for in-town lots, or out of town acreage, we have you covered! We'd love to find the perfect spot to meet your needs!
Land Information

Where are we going to build your dream home?
How many acres?*
Is your land apart of a subdivision?*

YesNoOther
What is the name of the subdivision?
What is the Lot Number?
Generally Lot, Block, and Phase numbers can be found on your land's survey.
What is the Block Number?
What is the Phase Number?
Address / Location*

Street or Nearest Road (We can apply for a 911 address if needed)

Street Address Line 2

CityState

Postal / Zip Code
Does your land have a gate code?*

YesNoOther
What is the gate code?*
This will be shared on a NEED TO KNOW basis.
Do you have a survey for this land?*

YesNoI'm not sureOther
Please upload the PDF of your survey. (PDF files only)

Cancelof
Is your land in the city limits?*

YesNoI'm not sureOther
Is your land in a flood plain?*

YesNoI'm not sureOther
Is your land subject to Extraterritorial Jurisdiction?*

YesNoI'm not sureOther
Are there any existing structures on your land?*

YesNo
What are they and whereabouts are they located?*
Is your land associated with an HOA?*

YesNoI'm not sureOther
HOA Primary Contact Name

First NameLast Name
HOA Primary Contact Phone
Please enter a valid phone number.
HOA Primary Contact Email
example@example.com
Is there a water meter or working well on the land?*

YesNoI'm not sureOther
Will your home's water be supplied by a well or by a municipal service?*

Water WellMunicipal ServiceI'm not sureOther
Which municipal service?*
Is there an existing electrical transformer on your land?*

YesNoI'm not sureOther
It would look similar to the one in the photo below.*

Yes! I do have one of those on my land!No, I'm sure I do not have one of those on my landI'm still unsureOther
That's ok. We can get that information later.
Last Questions

Some general information for us to get a better understanding of how best to serve you
How did you hear about Hayhurst Brothers Homes?*

InstagramFacebookBillboardJob Site SignPrint AdWord of MouthOther
How did you hear about Hayhurst Brothers?*
What type of home are you most interested in?*

Hayhurst Brothers Portfolio HomesHayhurst Brothers Simple Life SeriesBoth
Which 2 Hayhurst Brothers Portfolio Homes are you most interested in building? You can view each of these floor plans on our website.*

The BuckThe EmersonThe FaulknerThe FitzgeraldThe HemingwayThe L'AmourThe LondonThe McMurtyThe MelvilleThe PoeThe SteinbeckThe Twain
Which 2 Hayhurst Brothers Simple Life Series are you most interested in building? You can view each of these floor plans on our website.*

The AlpineThe LuckenbachThe MarfaThe TerlinguaThe Saint Jo
When are you wanting to start?*
What's the most important thing about your home to you?*
Any other note or thoughts?
Are you a human person that is breathing oxygen and actually interested in a Hayhurst Brothers Home?*
Should be Empty:

Client Information Form

Personal Information

Primary Contact

Secondary Contact

New Home Information

Financial Information

Whether you're looking for in-town lots, or out of town acreage, we have you covered! We'd love to find the perfect spot to meet your needs!

Land Information

That's ok. We can get that information later.

Last Questions