3 Percent Lead Form

1
Please Choose Your Suburb in Potchefstroom* This field is required.Choose "Other" if you cannot find your suburb...
Click to choose...
Click to choose...
Baillie Park
Dassie Rand
De Land Estate
Die Bult
Elandsheuwel AH
Grimbeeck Park
Haaskraal AH
Harpington AH
Heilige Akker
Kannoniers Park
Lekwena Wildlife Estate
Lifestyle estate
Lindequesdrif
Miederpark
Mooibank AH
Mooivallei Park
Potchefstroom Central
Turfvlei
Tuscany Ridge
Van Der Hoff Park
Vyfhoek
Vyfhoek AH
Waterberry Estate
Wilgeboom AH
Choose your suburb above
2
My Home Has X Bathrooms?* This field is required.Choose below ⬇️
1
Any
1
2
3
4
5+
3
My Home Has X Bedrooms?* This field is required.Choose below ⬇️
1
Any
1
2
3
4
5+
4
Does your home have a carport and/or garage?* This field is required.Choose below ⬇️
Select
Select
No Garage or Carport
Carport Only
Single Garage
Double Garage
Garage & Carport
5
Does your home have a pool?* This field is required.Choose below ⬇️
Select
Select
Yes
No
Pool in Complex
6
The Approx Size of My Home Is...?* This field is required.Choose below ⬇️
Select
Select
Less than 400m²
400m² or more
7
My Name & Surname:* This field is required.
First Name
Last Name
8
My E-mail:* This field is required.
9
My Phone Number:* This field is required.
Should be Empty: