First Name: Last Name:
Address Line 1:
Address Line 2:
City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code:
Email:
Home Phone: - - Work Phone: - -
Cell Phone: - - Fax: - -
Best Number To Call: Work Home Cell Best Time To Call: Morning Afternoon Evening
How Do You Prefer To Be Contacted? By Fax By Mail By Email
How Soon Are You Considering Building? Immediately 3-12 Months Uncertain
How Did You Hear About Us? Web Search Referral Lot Sign Radio Home Show Magazine Newspaper Ad Mailer Web Banner Other
Referral's Name (if applicable):
Credit: Excellent Good OK Poor Unknown Income: 0-40K 40-100K 100-150K 150K+ Debt: High Debt Medium Debt Low Debt No Debt Unknown
Assets: Under 5K Over 5K Over 10K Over 25K Over 50K Over 75K Over 100K No Assets Unknown Current Housing: Own Rent
Land: Indentified Land Land Contractor / Escrow No Land Own Land / Clear Own Land w/ Balance Looking For Land House Plans: Have Plans / Prints Working on Plans Want 1500 - 2000 1 sty Want 1500 - 2000 2 sty Want 2000 - 2500 1 sty Want 2000 - 2500 2 sty Want 2500 - 3000 1 sty Want 2500 - 3000 2 sty Want 3000 - 3500 1 sty Want 3000 - 3500 2 sty Want 3500 - 4000 1 sty Want 3500 - 4000 2 sty Want Above 3500 Want Below 1500 Duplex Unknown
Proposed New Home Value: Below 125K 125K - 150K 150K - 175K 175K - 200K 200K - 225K 225K - 250K 250K - 275K 275K - 300K 300K - 350K 350K - 400K Above 400K Unknown
Employment: Employed Employed w/ Other Income Retired Self-Employed Unemployed Marital Status: Married Single
Comments:
