Complete this form and let us find the perfect home for you.


  ABOUT YOU

Name:

Address:

City:

State:

Zip Code:

Daytime Telephone Number:

Evening Telephone Number:

E-Mail Address:


  RELOCATION INFORMATION
Are you relocating? Yes     No
Where are you moving?
When do you anticipate purchasing your new home?

  DESCRIBE YOUR DREAM HOME:
Type of Home:
Single Family          Mobile Home          Condo/Townhouse          Farmhouse
Approximate Price Between and 
Number of Bedrooms: 1   2   3   4   5   6+
Number of Bathrooms: 1   2   3   4+

  Interior Features and Preferences:

Living Room

Yes   No

Family Room

   Yes   No

Den/Study

Yes   No

Utility Room

   Yes    No

Sun Room

Yes   No

Fireplace

   Yes   No


  OTHER IMPORTANT INTERIOR FEATURES:

  Exterior Features and Preferences:

Garage

  Yes   No

Workshop

  Yes   No

Swimming Pool

  Yes   No

Fenced

  Yes   No

Acreage

  Yes   No

Porch/Deck

  Yes   No

  OTHER IMPORTANT EXTERIOR FEATURES:


  Please use this space for any additional comments or questions
  you may have.


Copyright 2005 [Patriot Realty U.S.A.]. All rights reserved.
Revised: July 31, 2016 .

Patriot Realty USA, LLC                        (731) 593-3540 and (731) 584-4900