Your First & Last Name
Today's Date
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Your Phone Number
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Your Email Address
What firm/company do you work for?
Buyers' Name(s)
Buyer's Address
City, State, Zip
Buyer's Phone Number
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Buyer's Email Address
How long has buyer been looking?
1 - 3 Months
3 - 6 Months
6 - 12 Months
More than 1 Year
When is buyer looking to move in?
Immediately
1 - 3 Months
3 - 6 Months
More than 6 Months
What is buyer's price range?
How many bedrooms/bathrooms?
If buyer has a budget for monthly payments, how much?
Has buyer been pre-qualified for a loan?
Yes
No
Paying Cash
May Need Owner Financing
Does buyer currently
own?
rent?
Does buyer need to sell current home before making a purchase?
Yes
No
What else can you tell us about your buyer's needs and wants?
Additional Comments: