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{price}
{bedrooms} bedrooms
{bathrooms} baths
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First Name:
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Last Name:
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Email:
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Address:
City:
State:
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Zip:
Please send me updates:
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?
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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
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$4,500,000
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$10,000,000
and
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$10,000
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$40,000
$45,000
$50,000
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$3,500,000
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$4,500,000
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$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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Carolyn Weller
Associate Broker, Realtor®
207-351-6717
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