Buyer Intake Form
Turning Dreams Into Addresses
Date
-
Month
-
Day
Year
Date
Name
First Name
Last Name
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you Married?
Please Select
Yes
No
Spouse Name
First Name
Last Name
Spouse Email
example@example.com
Spouse Address (If Different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Tell Me About Your Home
Indicate Price Range
$-$$$ USD
Have you been approved by a lender?
Please Select
Yes
No
If Yes Specify Lender Name
Are you currently working with another agent?
Please Select
Yes
No
Indicate the primary purchase of property
Please Select
Yes
No
What method of payment do you prefer?
Please Select
Cash
Loan
Preferred style of home
Single occupancy house
Apartment/Loft
Flat
Ranch Style
Bungalow
Split Level
Duplex
Number of Bedrooms
Number of Bathrooms
Square Feet
Enter a range (ex: 1000-2000)
Acres
Enter a range (ex: 1000-2000)
Amenities
Central Air Conditioning
Appliances
All Electric
Sky Lights
Other
Specify additional amenities
Additional Information
Submit
Should be Empty: