Name *

First Name

Last Name

Spouse or Other Name

First Name

Last Name

Primary Home Phone

(###)

###

####

Primary Cell Phone

(###)

###

####

When would you like to purchase your new property? *

Just Looking

0-2 Months

2-4 Months

4-6 Months

6 Months +

Unsure

Property Features *

Please check all that apply

Walk-Out

Mountain Property

Trees / Pines

Scrub Oak / Rock Outcroppings

Grassland

City Views

Mountain Views

Golf Course

Acreage

Agricultural

Hunting

Other

Is Well as a Water Source Okay? *

Please Check One

Yes

No

Need More Information

Is Septic as a Sewer Source Okay? *

Please Check One

Yes

No

Need More Information

Is Propane as a Gas Source Okay? *

Please Check One

Yes

No

Need More Information

Are Gravel Roads Okay? *

Please Check One

Yes

No

Need More Information

Is this a horse property?

Yes

No

Maybe