Name: 

Company: 

Address: 

City:      State:      Zip: 

Phone:       Fax: 

Approximate date of visit: 

Approximate date of relocation (if applicable): 

Area preferred: 

Do you prefer to be within City/Town limits? Yes No

Number of Bedrooms: 1 2 3 4 or more

Number of Baths: 1 2 3 4 or more

How Many Square Feet?: 

Lot Size: Less than 1 acre 1-2 acres 2-5 acres Over 5 acres

Single story preferred: Yes No No Preference

Type or Style: Select TraditionalGolf HomeFarmCabinLand OnlyCondoRanchOther 

Price Range: Under $25,000 $25,000 - 50,000 $50,000 - 100,000
$100,000 - 150,000 $150,000 - 200,000 $200,000 - 250,000
$250,000 - 300,000 $300,000 - 350,000 $350,000 - 400,000
$400,000 - 500,000 Over $500,000

I am interested in land only. Yes No
How Many Acres?: 

Please let us know of any special needs or comments:

E-Mail Address: 

Would you like to be placed on our mailing list ? Yes No
  If "Yes" be sure your E-mail address is entered above, in the space provided.

Are you interested in listing your property for sale with a
highly qualified real estate professional in your area?* Yes No