Your Contact Information  (Please complete all items)

First Name:                      Last Name:
    
EMail:                                                      Street Address:
   
City:                                           State/Province:           Zip/Postal Code:
       
Daytime Phone:                     Evening Phone:                    Fax:
         

If you are planning to sell your home, will it be within the next 6 months? 
   Yes No

DESCRIPTION OF THE HOME YOU WISH TO SELL.

Style of Home:  (eg. 2 levels, 1 level, bungalow, backsplit, etc.)
 

Approximate Square Footage: 

Lot Size: ft. Frontage X ft. Depth

Location: 

Type of Heating:  GAS OIL ELECTRIC OTHER   Age of Home: 

# of Bedrooms:  1 2 3 4 5 More # of Bathrooms:  1 1.5 2 2.5 3 3.5 4 More

Fireplaces:  YES NO MULTIPLE

Finished Basement:  YES NO No Basement

On a scale of 1-10 (with 1 being Poor and 10 being Exceptional),
please rate the showability of your home:
Poor 1 10 Exceptional

Special Features:
 

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