Name:
Email:
Address:
City:	State:
Zip Code:
Home Phone:	Fax:
I am interested in purchasing a home:

within next 30 days 30-90 days

90+ days from now just researching for now

I am interested in purchasing a home in the following areas:
Chesapeake	Emporia/Greenville	Franklin
Gloucester	Hampton	Isle of Wight
James City County	Mathews	Middlesex
Newport News	Norfolk	North Carolina
Northampton County	Outlying Virginia	Poquoson
Portsmouth	Smithfield	Southampton
Suffolk	Surry	Sussex
Virginia Beach	Williamsburg	York County
Preferred Style (please limit to 2 choices)
Colonial	Split Foyer	Farm/Victorian
Split Level	Rambler	Tudor
Contemporary	Condo	Estate
Townhouse	Custom	Other

Home Price range:	less than $100,000 $100,000-$125,000 $125,000-$150,000 $150,000-$175,000 $175,000-$200,000 $200,000-$225,000 $225,000-$250,000 $250,000-$300,000 $300,000-$350,000 $350,000-$400,000 $400,000-$450,000 $450,000-$500,000 $500,000-$750,000 $750,000-$1,000,000 $1,000,000 or higher
Min. Bedrooms required:
Min. Bathrooms required:
Other Room Selections:
Rec. Room  Library/Study  Family Room/Media Room Nanny/In-Law Suite  Sun Room
Basement:	Yes No
Lot Size:	less than 1/4 acre 1/4-1/2 acre 1/2-1 acre 1-3 acres 4-7 acres 8-10 acres 11-20 acres 20 or more acres
Age Ranges:	New 1-5 years 6-10 years 11-20 years 21-30 years Doesn't matter
Garage Spaces:	0-1 2 3 or more
Need to sell it first?	Yes No
Other Comments/Remarks: (Hobbies, sports, childrens' activities - so we may fine-tune your home search)