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Are you searching for your dream home? Let me help you. Please fill out and submit this form and I will add your criteria to our automatic email system. When listings that fit your criteria become available, you will be notified by email alerts.
Contact Information
First Name:
Last Name:
Email:
Phone:
Address:
City:
State or Canadian Province:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
South Dakota
Tennessee
Texas
US Territories and Possessions
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Zip Code:
General Information About Your Move
Where are you moving to:
State or Canadian Province:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
South Dakota
Tennessee
Texas
US Territories and Possessions
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
When do you anticipate
purchasing your new home?
Within 4 Months
Within 6 Months
Within 1 Year
No Date Set
Information About The Home You Are Looking For
Type of Home:
Single Family
Condo/Townhouse
Multi-family
Mobile Home
Farm
Land Only
Approximately priced between:
$0
$10,000
$20,000
$30,000
$40,000
$45,000
$50,000
$55,000
$60,000
$70,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
$5,000,000
$6,000,000
$8,000,000
$10,000,000
and
$0
$10,000
$20,000
$30,000
$40,000
$45,000
$50,000
$55,000
$60,000
$70,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
$5,000,000
$6,000,000
$8,000,000
$10,000,000
Number of Bedrooms:
1
2
3
4
5
6+
Number of Bathrooms:
1
2
3
4+
Interior Features & Preferences:
Living Room
Family Room
Fireplace
Hardwood Floors
Den / Study
Laundry Room
Other Important Interior
Features:
Exterior Features & Preferences:
Swimming Pool
Spa
Waterfront
Garage
Tile Roof
Fenced
Other Important Exterior
Features:
Additional Information
Have you ever been pre-qualified for a mortgage?
Yes
No
Do you have a down payment?
Yes
No
Have you had a credit report done lately?
Yes
No
Please use this space for any
other comments or questions
you might have.:
Connie Bath CENTURY 21 Pinnacle 228 South Broadway, Wind Gap, PA 18091
Phone: 610-393-0663 Toll-free Phone: 800-635-6240 ext 25 Fax: 610-863-7404 Email:
connie.bath@CENTURY21.com
©
CENTURY 21 Real Estate LLC. CENTURY 21
®
is a registered trademark licensed to CENTURY 21 Real Estate LLC.
Equal Housing Opportunity. Each Office is Independently Owned and Operated.