Buyer Registration Form

Your Name

Address (street, city, state, zip)

Home Phone

Office Phone

Cell Phone

Fax

Email

Preferred Property Size/Location

Preferred Property Description/Features

Earliest Buy Date

Latest Buy Date

Purchase Price Range

Monthly Payment Range

Amount Of Down Payment Available

Current Credit Condition

Credit Score (if known)

Reason For Bad Credit (if applicable)

Recently Denied Home Loan

Currently Own Or Rent Home

Do You Need To Sell Home

How Long At Current Residence

Address Of Advertised Home (if interested in a specific property)

How Did You Hear About Us

Are You Represented By A Realtor®

Ad Code (if applicable)

Comments / Questions