MOMENTS REAL ESTATE
1301 N Gravel Pike, Perkiomenville, PA 18074
www.moments.realestate
(215) 237-7660
getting to know you!
We look forward to partnering with you for your real estate needs!
Agent Name
*
First Name
Last Name
Agent Email
*
example@example.com
How did you hear about us?
*
Personal
Referral
Google
Past Client
Instagram
Open House
Facebook
For Sale Sign
Internet Ad
YouTube
Internet Search (Not Google)
Other
Other:
When would you like to be in a new home?
Right now! (90 days or less)
Soon (3 months or less)
Not sure (4 months +)
Please provide additional notes for your timeline:
job promotion, relocation, etc.
Do you currently own or rent?
Own
Rent
Live with relative/friend
Have you spoken to a lender for a pre-approval?
No
Started the process
Yes
If yes, what is the pre-approved amount?
$
If yes, what mortgage company?
How long have you been looking for a new home?
What tools, websites, or methods are you using?
What price range would you like your home to be?
How many bedrooms?
How many bathrooms?
Basement Details (select all that apply)
No
Yes - finished
Yes - unfinished
No preference
Garage Details (select all that apply)
No
Yes - detached
Yes - attached
1 car
2 car
3 car
no preference
Style/layout preference (Select all that apply)
Ranch
2-Story
Condo
Open layout
No preference
Style/layout notes:
Square footage?
What is your preferred location?
What schools, workplaces, social activities, and community amenities would you like to be near?
Name three (or more) things you MUST have in your next home (ex: yard, granite, garage, etc)?
Do you need to sell your present home to make this move?
Yes
No
Unsure
If we found your dream home today, are you ready to move forward?
Yes
No
Unsure
Is there anything else I need to know?
CONTACT INFORMATION
Client #1 Legal Name
*
First Name
Last Name
Client #1 Preferred Name
Client #1 Phone Number
*
Please enter a valid phone number.
Client #1 Email
*
example@example.com
Client #1 Current Address (Required for title work)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Legal Marital Status
*
Single
In a relationship
Married
Divorced
Widow/Widower
Preferred communication Method
Call
Email
Text
Select the social media platform you use:
Facebook
Instagram
None
Client #1 Birthday
-
Month
-
Day
Year
Date
Client #1 Occupation
Client #2 Legal Name
First Name
Last Name
Client #2 Preferred Name
Client #2 Phone Number
Please enter a valid phone number.
Client #2 Email
example@example.com
Client #2 Current Address (Required for title work)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Legal Marital Status
*
Single
In a relationship
Married
Divorced
Widow/Widower
Preferred communication Method
Call
Email
Text
Select the social media platform you use:
Facebook
Instagram
None
Client #2 Birthday
-
Month
-
Day
Year
Date
Client #2 Occupation
Children's Names, if applicable
Pet's Names, if applicable
Tell us about you! What's your favorite place to eat? Favorite drink, hobbies...
Check 'Yes, I would like to learn more' below if you would like to be considered for an opportunity to have your home buying experience documented. Disclaimer: not all candidates will be selected for filming.
Yes, I would like to learn more
No
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