Realtor® Form

How Did You Find Out About Sell4Free®? -- Select Your Answer -- Search Engine Real Estate Sign Television Radio Magazine Newspaper Referral Other

Type of Referral: -- Select Your Answer -- Buying Selling Both

Reason For Moving:

Agent Name:

Agent Phone Number:

Agent E-mail Address:

Agent License Number:

Broker of Record:

Real Estate Company:

Real Estate Company Address:

Client Name:

Client Phone Number:

Client E-Mail Address:

Client Address:

Property Information: -- Select Your Answer -- Buying Selling Both

Property Address:

Approximate Property Price:

Date Client Desires To Move:

Has Client Been Pre-Qualified By A Lender? Yes No

Will Part Of Client's Funds Be Coming From The Sale Of Another Property? Yes No

Best Way To Contact Prospect: -- Select Your Answer -- Phone E-mail Fax

Prospect E-mail Address:

Prospect Phone Number:

Price Range -- Select Your Answer -- Under $100,000 $100,000 - $150,000 $150,000 - $200,000 $200,000 - $250,000 $250,000 - $300,000 $300,000 - $350,000 $350,000 - $400,000 $400,000 - $500,000 Over $500,000

Down Payment:

Financing:

Desired Monthly Payment:

Type Of Home Desired: -- Select Your Answer -- 2 Story 2 Story With Basement Ranch Ranch With Basement Condominium Bi-Level Other

Number Of Bedrooms Desired: -- Select Your Answer -- 2 3 4 5 More Than 5

Number Of Bathrooms Desired: -- Select Your Answer -- 1 1.5 2 2.5 3 More Than 3

Desired Location: -- Select Your Answer -- Golf Course Water View City Country Other

Age Of Home Desired: -- Select Your Answer -- New 1 - 5 Years 5 - 10 Years Over 10 Years

Desired Time Frame: -- Select Your Answer -- Immediate Within 3 Months Within 6 Months Within 1 Year Other Not Sure

Does Prospect Have A Home To Sell? Yes No

Other Information: