Name ....................................

Street Address .......................

City........................................

State.......................................

Zip..........................................

Telephone...............................

Fax.........................................

Email Address........................

Area of Interest.......................

When would you be interested in moving

Do you have an agent working with you now? yes no

What price range would you like to look in?.............

How many square feet would you like?....................

How many bedrooms would you be interested in? ...

How many bathroom would you be interested in?....

Would you prefer an attached or detached garage? attached detached

Please put your dream home into words.

Would you prefer contact by: telephone email

Judy@Judyn.com