Housing Questionaire
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
Email
Best time to call?
Hour Minutes
AM
PM
AM/PM Option
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Housing Status
Homeowner
Rent/Leasing
Relocating
Housing Needs
New Home
Existing Home
Number of Bedrooms
1
2
3
More
Number of Bathrooms
1
2
3
More
Fenced Yard?
Yes
No
Close to Schools?
Yes
No
School Type
Public
Private
School Levels - Check all that apply
Elementary
Middle
High School
Close to Work?
Yes
No
Are you working with an agent?
Yes
No
Agents Name:
Housing payment budgeted:
Purchase price budgeted:
Additional Comments
Submit
Should be Empty: