Name: **

Street Address:

Address Line 2:

City:

Province:

Postal Code:

Phone:

E-mail: **

Do you have a specific area in mind (if so, provide details):

When are you planning on arriving?

What possession date do you require?

What price range are you looking for?

Do you have to sell the house you currently occupy in order to purchase?

< .. > Yes No

Have you been prequalified for a mortgage?

< .. > Yes No

Would you like a new home, or a home in a more established area?

Where will your place of business be located?

Are you familiar with the area?

< .. > Yes, a great deal Yes, a little No, not at all

How many bedrooms do you require?

What style of home would best fit your requirements?

Add any additional information you feel necessary: