Name Date
Phone   Email
                                       Address, City, State, Zip
 

Age  - - - 19-24 25-35 35-44 45-49 50-65 65+ Marital Status - - - Single Married Engaged Mingles Children
Needed - - - Immediately 3 months 3-6 months 6-9 months 9+ months Occupation - - - Exe,Mgmt Technical Self Professional Retail,Sales Goverment Retired  
Media Source - - - Magazine Direct Mail Internet Newspaper Referral Broker TV Signs Reason for moving - - - Job Family Change Tax Break Move Up First Home  
Desire - - - 1-story 2-story Basement Slab House Size - - - 3 bedroom 4 bedroom 4 + bedroom  
Price Desired - - - Under $100,000 $100 - $120 $120 - $150 $150 - $180 $180+ Total Income  
Present Residence - - - SF-Detached SF-Attached Condominium Apartment Parent-Relative Other Current Status - - - Own Rent Under contract Sold Home for sale
Intended Use - - - Investment 2nd home Primary Residence Other Preferred Activity - - - Golf Tennis Walking Biking Swimming other
Notes: