CUSTOM HOME
ORDER FORM
Who are you?
*
Homeowner
Builder
Realtor
Other
Are you a new builder with VirtuActive?
Yes
No
What brokerage are you associated with?
Company Name:
*
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Who are you representing?
*
Builder
Client
Do you have a builder?
*
Yes
No
NAME of Builder / Company
Do you have a client attached to this project?
*
Yes
No
Your Client's Name:
First Name
Last Name
Your Client's Email:
example@example.com
Your Client's Phone Number:
Please enter a valid phone number.
Responsible Billing Party?
*
Homeowner
Builder
Realtor
Other
Meeting Location:
*
VirtuActive Omaha Office - 1414 N 205th Street, Elkhorn, NE
VirtuActive Lincoln Office - 1701 Windhoek Drive, Lincoln, NE
Virtually via Google Meet
Other
Project Information
Project Address:
City:
Development:
Lot Number:
Survey Certificate Upload
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Please upload your survey certification below or email to Brittany (b.corey@virtuactive.com)
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Style of Home:
*
Ranch / 1 Story
1.5 Story (Primary Bedroom on Main Level)
2 Story (Primary Bedroom on 2nd Level)
Above Grade (Main and/or Upper Floor) Square Footage
*
Please list the approximate above grade square footage (Main Floor only OR Main Floor + Second Floor if applicable)
Below Grade (Finished Basement)
*
Please list the approximate below grade square footage (Unfinished Basement OR Slab Foundation would be zero sq ft)
Floor Plan Inspiration:
*
I have no plan as inspiration
I have multiple plans as inspiration
I have one plan and changes that need to be made
Other
Floor Plan & Photo Inspiration:
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Choose a file
If applicable please upload any plan(s) that you are using as inspiration along with any inspirational photos / images from Houzz, Pinterest, Mood Boards, etc. or email to Brittany (b.corey@virtuactive.com)
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Additional Information:
Please let us know if there is anything specific you would like us to know regarding this project.
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