Lead Form Contact Information First Name Last Name * Address * City * State Choose One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming South Dakota ZIP Email Day Phone * Cell/Pager Best Time to Call Choose One Anytime Morning Afternoon Evening Night Next Program & Property Type Buy/Rent Program Please Choose Rent Rent-to-Own Buy with Bank Financing Buy with Owner Financing Any of the Above Wholesale Residence Type Please Choose Apartment Condo Mobile Home Single Family Home Any of the Above Next Finish Financial Max Monthly Payment Please Choose $250 $300 $350 $400 $450 $500 $550 $600 $650 $700 $750 $800 $850 $900 $950 $1,000 $1,100 $1,200 $1,300 $1,400 $1,500 $1,600 $1,700 $1,800 $1,900 $2,000 $2,250 $2,500 $2,750 $3,000 $3,250 $3,500 $3,750 $4,000 $4,250 $4,500 $4,750 $5,000+ Max Down Payment Please Choose $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 $4,500 $5,000 $5,500 $6,000 $6,500 $7,000 $7,500 $8,000 $8,500 $9,000 $9,500 $10,000 $12,500 $15,000 $17,500 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000+ Retirement Account with Employer? Please Choose Yes No N/A Min Price Please Choose $1,000 $5,000 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $450,000 $475,000 $500,000 $550,000 $600,000 $650,000 $700,000 $750,000 $800,000 $850,000 $900,000 $950,000 Max Price Please Choose $5,000 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $450,000 $475,000 $500,000 $550,000 $600,000 $650,000 $700,000 $750,000 $800,000 $850,000 $900,000 $950,000 $1,000,000 How is your credit? Please Choose Excellent Good Fair Poor Ugly No Credit Next Finish Home Requirements How soon are you looking to purchase? Please Choose ASAP 1 month 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 12 months + Preferred Areas Bedrooms Please Choose Any 1 or more 2 or more 3 or more 4 or more 5 or more Bathrooms Please Choose Any 1 or more 2 or more 3 or more 4 or more 5 or more Square Footage Please Choose 500 sq ft or more 600 sq ft or more 700 sq ft or more 800 sq ft or more 900 sq ft or more 1000 sq ft or more 1250 sq ft or more 1500 sq ft or more 1750 sq ft or more 2000 sq ft or more 2250 sq ft or more 2500 sq ft or more 2750 sq ft or more 3000 sq ft or more 3250 sq ft or more 3500 sq ft or more 3750 sq ft or more 4000 sq ft or more Require Garage? Please Choose Yes No Require Basement? Please Choose Yes No Next Finish Special Requirements & Comments Some properties need work such as cleaning, painting, etc. If a property comes available that suits you and you could earn credits for doing work, would that interest you? Please Choose Yes No What are you willing to do or have done? Painting - Interior Painting - Exterior Light Cleaning Deep Cleaning Hauling away Landscaping Carpentry Drywall repair Drywall installation Plumbing HVAC Electrical Roofing Flooring/Carpeting Gutters Other Other special requirements Questions or comments Finish