How did you hear about us? Please choose Business Card Customer Referral Drove by office Email Flyer Flyer at House Internet Postcard Pottsville Republican Previous Buyer Previous Seller Sign on Car Sign on Property Sign on Street Thrifty Nickel Website Yellow Pages Yellow Pages Online
Buyer First Name   required
Buyer Last Name   required
Co-Buyer First Name
Co-Buyer Last Name
Street Address
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Evening Phone ( ) -
Cell Phone ( ) -        
Best Time to Call Please Choose Anytime Morning Afternoon Evening Night

What areas would you consider living?
How soon can you move after we find the home you want?
Would you consider a home that needs work? Yes   No
Minimum # of: Bedrooms   Baths    Square Footage

What is the most you can raise for a down payment?
Is your down payment available now? Yes   No
What is your ideal monthly payment?
What is your household income before taxes?
What is your current mortgage or rent payment?
What are your monthly debts?
How is your credit (excellent, good, poor, doesn't exist)?
How long have you been with your current job? 

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