E-mail Address
Title	Mr Mrs Mr & Mrs Ms Miss Atty Dr Rev
First Name
Last Name
Mailing Address
Street Address
City/Town
State	AL AK AZ AR CA CO CT CE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SD TN TX UT VT VA WA WV WI WY
Country	If outside of the United States
Zip Code
Home Phone Number	( ) -
Cell or Pager Number	( ) -	Personal Cell Work Cell Call As Needed Emergencies Only Spouse Friend Parents Other
Other Contact Number	( ) -	Work Call As Needed Work Emergencies Only Cell Phone Friend Parents Voicemail Pager
Best Time To Contact Me	9:00 AM -12:00 PM 12:00 PM - 3:00 PM 3:00 PM - 6:00 PM 6:00 PM - 9:00 PM 9:00 PM - 10:00 PM 7:00AM - 8:00 AM
Number of Children	Age range youngest to oldest
Number and Type of Pets

Press Ctrl to select more than one choice where permitted
Type of Home ranch split-level two-story cape multi-level bi-level two-family multi-family   Style of Home Choice #1   Traditional Colonial Contemporary Modern Custom Open Floor Plan Tudor Style Cottage Style Elegant Traditional Eclectic Cottage   Style of Home Choice #2   Traditional Colonial Contemporary Modern Custom Open Floor Plan Tudor Style Cottage Style Elegant Traditional Eclectic Cottage   Number of Bedrooms 1 2 3 4 5 6 6+   Number of Bathrooms 1 1.5 2 2.5 3 3.5 4+   Type of Garage none 1 - car attached 1 - car detached 2 - car attached 2 - car detached 3+ car attached 3+ car detached basement garage   Other Buildings   Shed Barn Greenhouse Stable Pole Barn Garage Apartment None   Type of Lot suburban area city country sub-division acreage estate lakefront private water/septic public water/sewer wooded open creek/pond private/exclusive   Type of Foundation concrete slab block crawlspace poured crawlspace block 1/2 basement poured 1/2 basement block full basement poured full basement garage in basement live-in basement 8 ft walls 9 ft walls   Type of Heating Fuel   Electric Natural Gas Propane Wood Wood or Corn Pellets Solar Enhanced Design Wood - Gas/Propane Backup Wood - Electric Backup Pellet - Gas/Propane Backup Pellet - Electric Backup Gas/Propane - Solar/Wood   Type of Main Heating Source forced air hot water baseboard wood stove pellet stove wood furnace pellet furnace   Air Conditioning Yes No   Air Locks at Entries Yes No   Ceiling Style   8 ft ceilings 9 ft ceilings 10+ ft ceilings vaulted ceilings cathedral ceilings   Skylights not necessary non venting venting   Desired Square Footage under 1000 1000 - 1250 1250 - 1500 1500 - 1750 1750 - 2000 2000 - 2500 2500 - 3000 3000 - 3500 3500+
Select Other Features Found In Your Home (choose all that apply)
Living Room		Family Room/Kitchen Combo
Dining Room		Eat In Kitchen
Family Room		Gourmet Kitchen
Great Room		Kitchen w/Island
Home Office		Library/Den
Master Suite		Glamour Baths
Guest Suite		Children's Suite
Game Room		Laundry Room
Nursery		Mud Room
Library		In-Law/Housekeeper Quarters
Foyer		Sunroom
Other Room		Type of Other Room

Do you need to sell your home due to pending foreclosure or other financial difficulty?		Yes No
Would you like a market analysis on your home?		Yes No
How much equity do you have in your home?
Do you have a second mortgage or other debt attached to your home?
I have already been pre-approved for:
I have saved money and dedicated it for closing costs and/or down-payment for home purchase in this amount:
Would you like a referral to a mortgage specialist?		Yes No

Desired Sale Price Range?   to The reason I want to sell my home is (click in the box and add your own text)   Retirement? Relocation? Type your reason here I need to relocate (click in the box and type your specific needs)   Need to relocate across town or worldwide? Our Coldwell Banker Family will help you! I want to retire and downsize   Tell me your plan or ask me what your options are Home Location - Desired Town/City?   Time Frame For Home Sale   immediately in the next 3 months 3 - 6 months 6 - 12 months Other Considerations