Home_Worth

Full Name

Address, City, State, Zip

Email

Home Phone

Preferred contact method? Phone E-mail

If by phone, which time is preferred? 9 - 11 AM 11 AM - 1 PM 1 - 3 PM 3 - 5 PM 5 - 7 PM 7 - 9 PM

PROPERTY LOCATION (Street, City, Zip)

Approximate lot size:

Approximate square footage of home:

Number of bedrooms: One bedroom Two bedroom Three bedroom Four bedroom Five or more bedrooms

Number of bathrooms: One bathroom Two bathroom Three or more bathrooms

Number of stories: One story Two story Three or more stories

Property type: Single family Townhouse Condo Duplex Triplex Manufactured Other

HOME IMPROVEMENTS / UPGRADES

When are you planning to sell? Within 3 months Within 6 months Within 6 - 9 months Within 1 year

Where will you be moving? (City & State)

Is your home currently listed? Yes No

Need to find a new home? Yes No