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RECEIVE A QUALIFIED EXCLUSIVE BUYER AGENT REFERRAL

Call us toll-free at 800.747.0122 for personal assistance to answer your questions and assist you in finding an Exclusive Buyer Agent in your area or use the form below.

Please complete the form below and our national office will find an Exclusive Buyer Agent to assist you. Exclusive Buyer Agent specialists provide you with the highest level of service.

I am interested in purchasing property in:

City:			State:			Preferred Areas, Neighborhoods or Counties:

Your Name:			Your Email Address:

Address 1:

City:

State:

Zip:

Address 2:

City:

State:

Zip:

Daytime Phone:		Secondary Phone:

Property Type:
	Single Family Home		Multi-Family Home
	Duplex		Condo/Townhome
	Co-op		Second home
	Land Only		Farm/Ranch Property
	Investment Property		Commercial Property

Minimum Number of Bedrooms:
	1 Bedroom		2 Bedrooms
	3 Bedrooms		4 Bedrooms
	5 or More Bedrooms

Minimum Number of Bathrooms:
	1 Bathroom		2 Bathrooms
	3 Bathrooms		4 Bathrooms
	5 or More Bathrooms

Approximate Price Range:
	Under $100,000		$100,000 to $150,000
	$150,000 to $200,000		$200,000 to $250,000
	$250,000 to $300,000		$300,000 to $400,000
	$400,000 to $500,000		$500,000 to $600,000
	$600,000 to $800,000		$800,000 to $1 Million
	Over $1 Million

When are you Thinking of Buying?
	As Soon as Possible		1 to 3 Months
	3 to 6 Months		6 to 12 Months
	Over 1 Year		When Present Home is Sold
	Undecided

If This is a Work Related Move (Relocation), Please Check One Below:
	Company Relocation		New Job
	Considering Moving and Need More Information

What are Your Financing Needs?
	Have Applied for Mortgage		Have Not Applied for Mortgage Yet
	No Mortgage Needed		Please Send me Mortgage Information

	I am a real estate agent seeking an exclusive buyer agent for an out of service area referral

	Comments: