Customer Information Form
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Client Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred method of contact
Phone call
Text message
Email
Financing and Home Pricing
Do you need assistance locating financing?
Yes
No
Have you been pre qualified, pre approved or informed as to what your maximum loan amount is?
Yes
No
If yes, will your financial company issue a pre-qualified/pre-approval letter stating the amount?
Yes
No
What monthly payment range would you feel comfortable with?
Other Information
How soon are you looking to move?
1 - 3 months
3 - 6 months
6 - 9 months
1 year +
Area of Interest
Do you need to sell your current home before purchasing a new home?
Yes
No
First time homebuyer
How many bedrooms would you prefer?
1 - 2
3 - 4
5+
Are you interested in a new construction, resale home or both?
New construction
Resale home
Open to both options
What features/amenities would you like in your new home?
Are you currently working with another real estate agent?
Yes
No
Additional Notes
Submit
Should be Empty: