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Date |
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First Name |
* |
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Last Name |
* |
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Street Address 1 |
* |
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Street Address 2 |
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City |
* |
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State |
*
|
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Zip Code |
* |
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Moving to State |
*
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E-mail Address |
* |
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Daytime phone number |
* |
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Evening phone number |
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Employer |
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New Hire or Transfer? |
New Hire
Transfer
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Do you want to purchase or rent? |
Purchase
Rent
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If purchase, what is your price range? |
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If rent, do you wish to rent |
Apartment
Home
|
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Desired monthly rental payment |
|
|
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Have you been in contact with Eagle Realty Group & Associates? |
Yes
No
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If yes, which Agent? |
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Children |
|
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Areas of Interest |
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Bedrooms |
|
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Bathrooms |
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Currently Own or Rent? |
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If Own, is Home Listed? |
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If yes, List Price |
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If moving to Fort Wood, when will you arrive? |
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If moving from Fort Wood, when will will you leave? |
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Does your employer provide Relocation Benefits? |
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If yes, which Relocation Company? |
|
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Have you been pre-qualified or pre-approved for a mortgage? |
Yes
No
|
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Would you like to talk with a lender? |
Yes
No
|
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Can we refer you to a Broker in your Area? |
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Other Needs or Wants |
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