| Required Information: |
Mr.
Mrs.
Ms.
Your Name:
|
| Address:
|
| City:
State:
Zip: |
| Home Phone:
Work Phone:
Fax: |
| Best Time to Contact You:
Morning
Afternoon
Evening |
| E-Mail Address:
|
| Additional Information: |
What type of
property are you interested in? (select
all that apply)
|
What price range are you interested in?
|
| Minimum No. Bedrooms:
|
| Minimum No. Baths:
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| Time frame for purchase:
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Interested in a Primary Home:
Interested in a Second Home:
Other: |
Presently Rent:
Presently Own Primary Home in Area:
Presently Own Second Home in Area:
Other: |
| Are you familiar
with our Lake Region of the Poconos?
yes
no |
Is
your interest:
If investment please list type:
|
Do
you favor any particular building style?
|
Any special features required? (select
all that apply)
|
What are your location choices? (select all that apply)
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| Will you need a mortgage?
yes
no |
| If so, have you been pre-qualified?
yes
no |
Other Requirements:
|
| Would you like to be in our mailing
list?
yes
no |
| I agree I have read the consumer
notice located on this website.
|