Required fields

Name
Occupation
Address
City
State
Zip
Daytime Phone
Evening Phone
Email
Sales Person
Present Residence
 Apartment
 Condominium
 Single Family Home
 Other
Do You Own This Residence?
 Yes
 No, I am renting
What Is Your Current Monthly Payment?
When Will You Need A New Home?
 Immediately (1 month)
 Soon (1-3 months)
 Near Future (3-6 months)
 Within a Year (6-12 months)
Price Range Desired?
 $275, 000 - $350,000
 $350,000 - $425,000
 $425,000 - $500,000
 $500,000 - $575,000
 $575,000 - $650,000
 $650,000 and Up
How did you first learn about us?
 Internet
 Detroit News / Free Press
 Other Newspaper
 Magazine
 Referral
 Direct Mail
 Roadside Signs
 Driving Around
 Other
Monthly Payment Range Desired?
 Under $1,000
 $1,000 - $1,250
 $1,250 - $1,500
 $1,500 - $1,750
 $1,750 - $2,000
 $2,000 and Up
What Features Are Important To You?
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