Intake Form
Full Name
*
First Name
Last Name
Spouse/Partner Name
Spouse/Partner First Name
Spouse/Partner Last Name
Full Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell phone
*
Please enter a valid phone number.
Email
example@example.com
Timeline
*
Please Select
< 1 year
1-3 years
> 3 years
Service Needed
*
Please Select
Buy a Home
Sell a Home
Buy and Sell a Home
I'm a Landlord
I'm looking to rent
Parking?
Please Select
Yes
No
Pets?
Please Select
Yes
No
How many and what types?
Smoking?
Please Select
Yes
No
Will you accept the housing voucher?
Please Select
Yes
No
Property Address:
*
# BR:
*
# BA:
*
Ideal Rental Amount:
*
Max # of People?
*
What is the current condition of property?
Please Select
1
2
3
4
5
6
7
8
9
10
Number of Bedroom?
*
Number of Bathroom?
Square Footage?
Lot size?
Property Type?
Please Select
Single-Family
Multi-Family
What is your Ideal selling price?
Property Siding
Please Select
Brick
Frame
Stucco
Have you been preapproved for a loan?
*
What is your ideal BR count?
*
What is your ideal BA count?
*
What is your ideal purchase price?
*
What is your annual income?
Please Select
< 50K
50 - 75K
75 - 100K
> 100K
What is your current credit score?
Please Select
< 500
501 - 600
601 - 650
651 - 700
> 700
Which areas are of interest to you?
Bronx
Brooklyn
Queens
Staten Island
Manhatten
Nassau Country
How many People are in your household?
Do you currently have any pets?
Please Select
Yes
No
How many and what type?
Are there smokers in your household?
Please Select
Yes
No
Why are you moving?
Are you currently employed?
Please Select
Yes
No
Do you receive paystubs at your current job?
Please Select
Yes
No
How long have you been with your current employer?
Do you have a housing voucher?
Please Select
Yes
No
Which housing voucher do you have?
How long have you had this housing voucher?
What amount is the housing voucher for?
Are you able to provide 1 personal (non-relative) and 1 professional reference?
Please Select
Yes
No
Submit
Should be Empty: