Street Address

City

State

Zip

Phone Number

E-Mail Address

Family size
1 2 3 4 4+

Children?
None Pre-school School-age

How long have you been in the market for a new home?
Less than a month 1-3 months 3-6 months Over 6 months

What is your reason for moving?

Do you have a home to sell?
Yes No

What features are most important to you in a new home?

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