First Name: *
Last Name: *
How did you hear about my website
Choose One
Internet Search
Chamber of Commerce
Other Web Site
Advertisement
Friend
Other
E-Mail *
Your Phone Number
Your Fax Number
Allowed to Call?
Yes
No
Address:
City:
Province
Postal Code
Country
Whose name is the home titled in
Are you living in the home, is it rented or is it vacant
Choose One
Living in the home
Renting the home
Not in the home, it is vacant
Age of Property
How long have you owned this property
Choose One
Less than 1 year
1-3 Years
3-5 Years
5-10 Years
10-20 Years
Longer than 20 Years
Unknown amount of time
What style home do you have
How many bedrooms do you have?
Choose One
1
2
3
4
5
How many baths do you have
What type of exterior siding do you have
Choose One
Aluminum
Brick
Stone
Vinyl
Wood
Shingle
Stucco
Combination
Other
What type of foundation do you have
Choose One
Full Basement
Partial Basement
Crawl Space
Concrete Slab
Combination
Other
What type of heating system do you have
Choose One
Natural Gas Furnace
Propane Gas Furnace
Gas Hot Water Boiler
Electric Hot Water Boiler
Electric Furnace
Electric Baseboard
Electric Heat Pump
Electric Radiant Heat (in the ceiling)
Fuel Oil Furnace
Wood Furnace Addon
Wood Stove (free standing)
Wood Stove (fireplace insert)
Fireplace
Geothermal
Other
What type of air conditioning do you have
Choose One
Central Air
Heat Pump
Window Air
Wall Unit Air
Attic Fan
Geothermal
Other
What type of Garage do you have
Choose One
1 Car
1 1/2 Car
2 Car
2 1/2 Car
3 Car
3 1/2 Car
4 Car or Larger
Pole Barn
Attached
Detached
Combination
Other
None
What type of roof do you have
Choose One
Shingle
Slate
Metal
Tile
Wood Shakes
Combination
Other
How many square feet do you have above the basement
Choose One
Under 1,000
1,000 - 1,500
1,500 - 2,000
2,000 - 2,500
2,500 - 3,000
3,000+
Unknown
Tell me about any recent improvements or updates that you think will help your homes resale
Have you had the home appraised within the past 5 years
Yes
No
What would you estimate the value of your home to be? Number format only. Example: 150,000.00
What is a good time to contact you to set up a time for us to view your home
Do you want to buy another home
Choose One
Yes
No
