Untitled Form 1

First Name:

Last Name:

Phone:

E-mail:

Best time to Contact: (choose one)

Buying or Selling a home? (choose one)

COMPLETE THIS SECTION IF BUYING A HOME

What geographic area are you interested in? (Examples: West side of South Bend, Granger, etc.)

What is your approximate cost range?

List any additional information you would like to provide:

COMPLETE THIS SECTION IF SELLING A HOME

Street Address:

City:

Zip:

Approximate Acreage:

Square footage:

Bedrooms:

Bathrooms (Full + Half):

List any additional information you would like to provide: