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General Information About Your Move
Where are you moving?
State:
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
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ND
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NH
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NM
NV
NY
OH
OK
OR
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SD
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TX
UT
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VT
WA
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When do you anticipate purchasing your new home?
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within 4 months
within 6 months
within a year
no date set
Information About The Home You Are Looking For
Type of Home:
Single Family
Condo/Townhouse
Multi-family
Mobile Home
Farm
Land Only
Approximately priced between:
select one
$0
$10,000
$20,000
$30,000
$40,000
$45,000
$50,000
$55,000
$60,000
$70,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
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$325,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
$5,000,000
$6,000,000
$8,000,000
$10,000,000
and
select one
$10,000
$20,000
$30,000
$40,000
$45,000
$50,000
$55,000
$60,000
$70,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$400,000
$450,000
$500,000
$550,000
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$650,000
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$750,000
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$850,000
$900,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
$5,000,000
$6,000,000
$8,000,000
$10,000,000
Number of Bedrooms:
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1
2
3
4
5
6
Number of Bathrooms:
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1
2
3
4+
Interior Features & Preferences:
Living Room
Family Room
Fireplace
Hardwood Floors
Den / Study
Laundry Room
Other Important Interior Features:
Exterior Features & Preferences:
Swimming pool
Spa
Waterfront
Garage
Tile roof
Fenced
Other Important Exterior Features:
Additional Information
Have you ever been pre-qualified for a mortgage?
No
Yes
Do you have a down payment?
No
Yes
Have you had a credit report done lately?
No
Yes
Please use this space for any other comments or questions you might have.
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Todd and Karen Cerino
REALTORS®
703-201-8898
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