* = information is required to respond to your request   

Name*
Address*
Address (cont.)
City*
State*	AKALARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTTTXUTVAVIVTWAWIWVWY
Zip*
Email*
May I contact you by phone?	Yes Not now. Please contact me by email.
If yes, which is the most convenient to you?	Day Phone Evening Phone
Day Phone
Evening Phone
Fax
When will you sell?

You MUST provide phone, fax and/or email information, above, so I can contact you with your FREE Market Valuation.

Tell about your home:

1. Location: 

   Street address
   Address (cont.)
   City
   State/Province
   Zip/Postal code
   (Other) Country

2. Number of Bedrooms:
   
3. Number of Bathrooms: Full 3/4 1/2
   
4. Study: Yes No
   
5. Formal Dining Room: Yes No
   
6. Family Room: Yes No
   
7. Year Built:
   
8. Interior Square Footage:
   
9. Approximate lot size:
   
   
10. Spa/Hot Tub: Yes No
    
11. Central AC: Yes No
    
12. Number of Stories: 1 2 3
    
13. Basement: Yes No
    
14. If you have a basement, what portion is finished?
    None
    1-25% 26-50% 51-75% 76-100%
    
15. Interior condition: Excellent Normal Poor
    
16. Exterior Condition: Excellent Normal Poor
    
17. Garage: None 1 car 2 car 3 car 4 car
    Attached Detached
    
18. Describe any recent remodeling:
    
    
19. Describe any special features that you think contribute to
    your home's market value.
    
    
20. In your opinion, what do you think your property is worth?
    
    
21. What Search Engine or Directory did you use to find this Web site?
    Make a selection Alta Vista Excite! InfoSeek IRED LinkStar Lycos Open Text Magellan Meta Search Saavy Search Webcrawler Yahoo! Other (Specify below)
    Other:
    
22. What Keywords did you use to find this Web site?
    

You MUST provide phone, fax and/or email information, above, to receive your FREE Market Valuation.