Name:

Address:

City:

State:

Zip Code:

E-mail Address:

Home Phone:

Work Phone:

Fax:

Approx. Price: under $100k $125,000 $150,000 $200,000 & over

Plan on moving:
3 months
6 months
1 year
Longer

Trip to Florida Planned for:

How did you find us?

On line search
Newspaper
Advertising
Other

Do you need a mortgage?

Yes
No

Have you had contact with a mortgage company or bank?

Yes
No

If Yes, are you pre-approved?

Yes
No

What Mortgage / Bank?

If No, Do you want to complete an application over the Internet:

Yes
No

I must sell my existing home before buying a new one:

Yes
No

My new home will be a

Primary Residence
Seasonal Residence
Investment

Comments:


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The property described herein and the online information source are both situated within the State of Florida. This posting is provided solely for informational purposes. All information is subject to change without notice and information you deem important may be omitted.