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Contact Information:

First Name:
Last Name:
Address:
City:		State:	CT MA	Zip:
Email Address:
Home Phone:	- -
Property Information:
	Check here if address is the same as above.
Address:
City:		State:	CT MA	Zip:
Resident Status:	Primary Residence Secondary Residence Vacation Home Rental	Bedrooms:	0 1 2 3 4 5 6 7 8 9 10
Relationship:	Legal Owner Renter Landlord Property Manager Potential Buyer Other	Bathrooms:	0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
Property Type:	Single Family Multiple Family Townhouse Condominium	Parking:	Garage Car Port On Street Off Street No Covered Parkiing
Condition:	10 Excellent 9 8 7 6 5 4 3 2 1 Poor	Spaces:	None 1 Car 2 Cars 3 Cars 4+
Lot Size:	City Lot 1/2 Acre 1 Acre 2 - 5 Acres 5 - 10 Acres 10+ Acres Unsure	Listing Status:	No Currently Listed For Sale By Owner Yes - With an Agent
Basement:	Finished Partially Finished Unfinished None	Planning to Sell:	30 Days 60 Days 90 Days 6 Months 1 Year
Heat Type:		Home Style:
Air Conditioning Type:		Approx. Year Built:
Where will you be moving:		# of Fireplaces:
Approx. Sq Feet:		Rooms:	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
	PoolWater FrontWater View
Comments:
Are you currently working with a Real Estate agent?			No Yes
If yes, Listing Agent:		Last Name:
		First Name:
If No, Would you like to request a specific agent?
		Last Name:
		First Name: