Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
FAX
E-mail

        How soon would you like to move / build    One to Three Months Three to Six Months Six to Twelve Months Twelve to Eighteen Months More thatn 24 Months

         What price range do you desire. ?     $

         Do you currently:    Rent          Own     Both

         Do you own a lot or property where you would like to build. ?     Yes   No

         Do you need assistance in finding a lot ?    Yes   No

         Do you need assistance in acquiring a loan ?    Yes     No

         Do you need assistance in designing a custom plan ?     Yes     No

         What size home are you in the market for (approx. sq. ft.) ? 

         Specify the number of bedrooms desired: 2 3 4 More

         Specify the number of bathrooms desired: 2 3 4 More

          Any additional comments or requirements ?