ELIANA MILLAN
REALTOR
JACKSONVILLE, FL.
(901)6077214
ElianaMillanRealtor@gmail.com
Client Information for Real Estate
Please complete all questions.
Type of Insvestment? Tipo de Inversion
Casa Primaria
Segunda Casa
Inversión
Fix and Flip
Name-Nombre y Apellido
*
First Name
Middle Name
Last Name
Address-Dirección
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
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Angola
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The Bahamas
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Botswana
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Burkina Faso
Burundi
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Canada
Cape Verde
Cayman Islands
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Chile
China
Christmas Island
Cocos (Keeling) Islands
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Cook Islands
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Cote d'Ivoire
Croatia
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Denmark
Djibouti
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Falkland Islands
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The Gambia
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Lebanon
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Libya
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Malaysia
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Malta
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Moldova
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Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
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Turks and Caicos Islands
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Vatican City
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British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
E-mail
*
Home Number- Teléfono casa
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Area Code
Phone Number
Cellular Number- Numero celular
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Area Code
Phone Number
Work Number- Numero Tlf Trabajo.
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Area Code
Phone Number
Locations Interested In- Locación que te interesa?
Cities, Towns, Counties, Areas
# of Bedrooms
# of Bathrooms
Square Feet
Price Range $
Maximum Down Payment (If Applicable)
Have you been pre qualified before? - Has estado calificado antes?*
Do you Work with ? Trabajas con ?
1099 (Trabajador Independiente)
W2 ( Empleado de una Compa#ia)
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