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First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
E-mail
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Relationship: Choose One owner renter potential buyer other    Type: Choose One Single Family Home Condominium Cluster/Townhome Multiple family Other    Style: Choose One Colonial Cape or Bungalow Ranch Raised Ranch Split Level Two Story Other                  

Year Built:                           Square footage:             Condition:    Choose One 1 Poor 2 3 4 5 6 7 8 9 10 Excellent

# of Bedrooms:  Choose One 1 2 3 4 5 6 or more     # of Baths: Choose One 1 1.5 2 2.5 3 3.5 4 4.5 5 or more      Parking:  Choose One 1 car garage 2 car garage 3 car garage or larger carport none

Basement:   Choose One Slab Full Finished Full Unfinished Partial Finished Partial Unfinished     Lot Size:  Choose One City lot Less than 1/2 acre 1/2 acre but less than 1 acre 1-2 acres 2-5 acres 5+ acres Not sure     Pool:  Choose One Yes No

Heating:  Choose One Gas forced air Gas baseboard Oil forced air Oil baseboard Electric Heat Pump Propane fired Other   Cooling: Choose One Central air Window air conditioners Attic Fan None Other         # of fireplaces:           

Planning to Sell:  Choose One Immediately 3-6 months 6-12 months Not sure No intention of selling     Current Status:  Choose One Not yet listed Listed with agent For Sale by Owner

Improvements or special features that affect value:

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