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Name:
Email Address:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Best Time to Call:
Currently Own?:
Currently Rent?:
Must Sell to Purchase?:
Your Needs and Wants
Area of Interest (SLC, Ogden, etc):
Purchase?:
Rent?:
Possession Date:
Price Range Preference:
$0-$50,000
$50,000-$100,000
$100,000-$150,000
$150,000-$200,000
$200,000-$300,000
$300,000 +
Type of Home:
Single Family
Dup/Tri/Fourplex
Vacant Land
Farm or Ranch
Commercial
Multi-Family
Condo
Number of Bedrooms:
1
2
3
4
5+
Number of Bathrooms:
1
2
3
4+
Dining Room:
Family Room:
Basement:
Fireplace:
Garage:
NONE
1 Car
2 Car
3 Car
Other
Features:
Comments:
