BLONDE NEW YORK — Client Intake
A professional intake form for rental, purchase, sale, investment, or relocation inquiries. Please provide only the information requested, and note that this intake is administrative and may require separate disclosures or documents depending on the transaction.
Service Requested
Service Requested
*
Rent
Buy
Sell
Invest
Relocation
Other
Is the property/search located in New York City?
*
Yes
No
Unsure
Client / Submitter
Full Name
*
First Name
Last Name
Preferred Name
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Preferred Contact Method
*
Phone
Email
Text
Are you completing this for yourself?
*
Yes
No
Submitter Role / Relationship
*
Please Select
Agent
Attorney
Family Member
Friend
Care Provider
Caseworker
Agency Representative
Other
Organization
*
Submitter Name
*
Submitter Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Submitter Email
*
example@example.com
Authorization Confirmation
*
I confirm that I am authorized to provide this information on behalf of the client.
Search / Transaction Profile
Accessibility-related property features requested
Preferred boroughs/neighborhoods
*
Manhattan
Brooklyn
Queens
Bronx
Staten Island
Long Island City
Upper East Side
Upper West Side
Williamsburg
Park Slope
Harlem
Chelsea
Astoria
Other
Target move / transaction date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Bedrooms
Bathrooms
Budget / maximum rent or purchase price
Rental Assistance / Lawful Source of Income
Lawful source of income, including housing vouchers and subsidies, is protected and is not used to exclude or steer clients.
Please select any lawful sources of income or housing assistance that may apply
Section 8 / NYCHA HCV
CityFHEPS
FHEPS
HASA
HPD/HCV
Public Assistance
SSI/SSDI
Employment/Wages
Other Lawful Source
Prefer Not to Say
Household size
Pets in household
Yes
No
Notes and preferences
Financial Readiness
Approximate Income Range
Please Select
Under $30,000
$30,000–$49,999
$50,000–$74,999
$75,000–$99,999
$100,000+
Prefer not to say
Current Employment or Income Source
Please Select
Employed full-time
Employed part-time
Self-employed
Retired
Student
Government benefits
Unemployed
Other
Required Housing/Search Documents Ready
*
Government-issued voucher or shopping letter
Proof of funds
Recent pay stubs
Employment verification
Other approved housing/search document
Optional Secure Document Upload
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Referral / Caseworker Information
Referral Source
Please Select
Online Search
Friend or Family
Social Media
Community Organization
Caseworker/Housing Specialist
Brokerage/Agency
Other
Caseworker / Housing Specialist Name
First Name
Middle Name
Last Name
Organization
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
BLONDE NEW YORK
Brokerage / Agency Disclosure
Legal brokerage name:
A Blonde New York LLC
NYS Real Estate Broker License #10491214109
Representative Broker:
Travial McCall
Licensed Real Estate Salesperson:
Xavion Gonzalez, NYS License #10401397489
NYC FARE Act Notice
A broker or agent representing a landlord may not charge that broker fee to the prospective tenant. Renters may separately engage their own broker, subject to lawful written terms. Learn more: https://www.nyc.gov/site/dca/about/FAQ-Broker-Fees.page
I acknowledge this notice
*
Acknowledged
Acknowledge disclosure
*
I understand this intake is administrative only and does not create an agency relationship, listing agreement, exclusive representation agreement, or a guarantee of housing or transaction. I have reviewed the required disclosure forms: https://dos.ny.gov/landlord-and-tenant-disclosure-form-english and https://dos.ny.gov/buyer-and-seller-disclosure-form-english. I understand that separate agency disclosure or representation documentation may be required based on the transaction.
I acknowledge
Fair Housing & Equal Housing Opportunity
Equal Housing Opportunity Notice
I acknowledge I have been shown the fair-housing resources and understand this does not replace any separate official disclosure form required by law. Links: https://dos.ny.gov/housinganti-discrimination-form | https://www.hud.gov/helping-americans/fair-housing-act-overview
*
Acknowledged
Privacy / Communications
Consent to be contacted about this inquiry
*
Phone
Email
Text message
I agree to receive marketing updates and offers
Email
Text message
Phone
Certification and E-Signature
I certify that the information provided is accurate to the best of my knowledge
*
I certify that the information provided is accurate to the best of my knowledge
Typed Signature / Full Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Acknowledgment of Disclosures
*
I acknowledge that I have reviewed and understood the required disclosures
Internal Admin-only / Hidden Fields
Assigned Agent
Please Select
Agent A
Agent B
Agent C
Other
Intake Review Status
Please Select
Pending Review
In Review
Approved
Needs Follow-Up
Closed
Review Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Internal Notes
Next Step
Please Select
Call Client
Request Documents
Schedule Consultation
Assign Agent
Close File
Other
Source Campaign
Please Select
Organic Search
Paid Search
Social Media
Email Campaign
Referral
Open House
Other
Referral/Partner ID
Save
Submit Inquiry
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