CENTURY 21 LEGACY........... Call 469-583-3538
Property Request
Contact Information
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First Name:
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Last Name:
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Email:
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Phone:
Address:
City:
State:
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CA
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KS
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LA
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MD
ME
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MT
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NM
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NY
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Zip:
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Alex Coulonge
Amanda Long
Angela Grelle
Angie Paquette
Burleigh Foreman
Denise Sherwood
Emma Polman
Gayle Gonzalez
Jay Stevens
Jay Waheed
Jennifer Morris
Joetta Allen
Joey Herald - The Family Man
Kathleen Ryan
Larry Hoffman
Lisa Cochell
Lorie Hays
Magdalena Fay
Mike Marion
Monte Hazelton
Mush Amed
Paulino Rodriguez
Pete Martinez
Roxanne Hopewell
Steve Beyer
Steve Mitchell
Tony Salgado
Troy Ottwell
General Information About Your Move
Where are you moving?
State:
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
When do you anticipate purchasing your new home?
select one
within 4 months
within 6 months
within a year
no date set
Information About The Home You Are Looking For
Type of Home:
Single Family
Condo/Townhouse
Multi-family
Mobile Home
Farm
Land Only
Approximately priced between:
select one
$0
$10,000
$20,000
$30,000
$40,000
$45,000
$50,000
$55,000
$60,000
$70,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
$5,000,000
$6,000,000
$8,000,000
$10,000,000
and
select one
$10,000
$20,000
$30,000
$40,000
$45,000
$50,000
$55,000
$60,000
$70,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
$5,000,000
$6,000,000
$8,000,000
$10,000,000
Number of Bedrooms:
select one
1
2
3
4
5
6
Number of Bathrooms:
select one
1
2
3
4+
Interior Features & Preferences:
Living Room
Family Room
Fireplace
Hardwood Floors
Den / Study
Laundry Room
Other Important Interior Features:
Exterior Features & Preferences:
Swimming pool
Spa
Waterfront
Garage
Tile roof
Fenced
Other Important Exterior Features:
Additional Information
Have you ever been pre-qualified for a mortgage?
No
Yes
Do you have a down payment?
No
Yes
Have you had a credit report done lately?
No
Yes
Please use this space for any other comments or questions you might have.
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Century 21 Legacy
469-583-3538
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