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* Denotes required field
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| How did you hear about us?
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Newspaper
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Magazine
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Internet / Web site
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Realtor
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Other
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| How soon will you be needing your home?
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With in 30 days |
1 to 3 months |
| 3 to 9 months |
Over 9 months
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| How long have you been looking for a home?
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Under 30 days |
1 to 3 months |
| 3 to 9 months |
Over 9 months
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| Which activities do you participate in?
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Golf
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Fishing
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Skiing / Winter Sports
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Hiking
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Boating
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Biking
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Swimming
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Aerobics / Fitness
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Horseback Riding
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Team Sports
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Tennis / Recquetball / Squash
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| Type of Home |
Number of Bedrooms
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| Home Use |
Square Footage Desired
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| Price Range
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What is your age?
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| Are you married?
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How many children do you have living at home?
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Yes
No
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*First Name
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*Last Name
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*Email
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Address1
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Address2
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City
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State
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Zip Code
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Home (Evening) Phone
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Work (Day) Phone
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Fax
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Best time to have a representative contact you |
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County
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Occupation
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Comments and Suggestions
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