Contact Information

First Name:

Last Name:

Phone Number:

Fax Number: (optional)

Street Address:

City:   State:   Zip:

E-mail Address:

Best Time to Contact: MorningAfternoonEarly EveningEvening Time Zone: PacificMountainCentralEastern

Preliminary Information

When are you moving?: Within 30 days30 to 60 days60 to 90 days3 to 6 months6 months or more

Do you need relocation assistance?: NoYes

Are you pre-qualified with a mortgage broker?: NoYes

   If yes, with whom?:

   and for how much?: under $300,000$300,000 - $400,000$400,000 - $500,000$500,000 - $600,000$600,000 - $700,000$700,000 - $800,000$800,000 - $900,000$900,000 - $1 million$1 million - $1.5 million$1.5 million or more

Do you have a down payment readily available?: No5%10%20%< 20%

Have you purchased or sold real estate in the past?: NoYes

Are you currently working with an agent?: NoYes

   If yes, for how long?:

Wish List

Area (please check all that apply):

Belvedere  Corte Madera  Fairfax  Larkspur

Mill Valley  Novato  Ross  San Anselmo

Sausalito  San Rafael  Tiburon

Price Range: under $300,000$300,000 - $400,000$400,000 - $500,000$500,000 - $600,000$600,000 - $700,000$700,000 - $800,000$800,000 - $900,000$900,000 - $1 million$1 million - $1.5 million$1.5 million or more

Number Bedrooms: 23456+   Bathrooms: 12344+

Sq. Footage: > 10001000-12001200-14001400-16001600-18001800-20002000-22002200-26002600-30003000+   Yard?: NoYes   Garage?: NoYes

Would you be willing to meet with one of our agents for an introductory discussion, with no obligation for either party?: NoYes

Other Requests or Comments (optional):