Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Type of Home:	Single Family Home Condominium/Townhome Residential Income Mobile Home Lots and Land
Number of Bedrooms:
Number of Full Baths:
Number of Half Baths:
Dining Room:	Yes No
Family Room:	Yes No
Office/Den:	Yes No
Fireplace:	Yes No
Swimming Pool:	Yes No
Garage:	None 1 Car 2 Car 3 Car 4 or more Car
Carport:	None 1 Car 2 Car 3 Car 4 or more Car
Square feet:
Year Built:
Special Features:
When are you planning on selling your property?
Within the next  1 2 3 4 6 12 months
Please tell me how to contact you?
First Name
Last Name
Home Phone
E-mail