Name :

                  Street Address:

                                 City:

                         Zip Code :

                 Type of House : Choose One Single Family Home Multiple Family Home Townhouse Condominium Vacant Land Other

                        Year Built :

       Number of Bedrooms :

       Number of Bathrooms :

               Square Footage :

       Condition of Property : Please select Excellent 1 2 3 4 5 6 7 8 9 Poor

                            Parking: Choose One Car Port No Covered Parking Attached Garage Detached Garage Other

             Residence Status : Choose One Primary Residence Secondary Residence Rental Other

    Relationship to Property : Choose One Legal Owner Renter Landlord Property Manager Potential Buyer Other

                   Listing Status : Choose One Not Currently Listed For Sale by Owner Already Listed Other

           Planning to Sell In : Choose One Right Away 90 Days 6 Months Not Planning to Sell