If you provide us with as many details as possible below, we will be better able to serve your needs:
*Name :
 
  
 
 
 
*E-mail: 
 
 
 
 
Phone (day):
 
 
 
 
Phone (evening):
 
 
 
 
What is a good time to contact you?
 
 
 
 
If you can receive information by fax, what is the fax number?
 
 
 
 
Would you like Montgomery relocation package?
 
 Yes  No 
If yes, please include your address!
 
 
Your mailing address:
 
 
 
City:
 
 
 
 
State or Province:
 
 
Outside US and Canada 
Alabama 
Alaska 
Alberta 
American Samoa 
Arizona 
Arkansas 
Armed Forces 
British Columbia 
California 
Colorado 
Connecticut 
Delaware 
District Of Columbia 
Florida 
Georgia 
Guam 
Hawaii 
Idaho 
Illinois 
Indiana 
Iowa 
Kansas 
Kentucky 
Louisiana 
Maine 
Manitoba 
Maryland 
Massachusetts 
Michigan 
Minnesota 
Mississippi 
Missouri 
Montana 
Nebraska 
Nevada 
New Brunswick 
New Hampshire 
New Jersey 
New Mexico 
New York 
Newfoundland 
North Carolina 
North Dakota 
Northern Mariana Is 
Northwest Territories 
Nova Scotia 
Ohio 
Oklahoma 
Ontario 
Oregon 
Palau 
Pennsylvania 
Prince Edward Island 
Province du Quebec 
Puerto Rico 
Rhode Island 
Saskatchewan 
South Carolina 
South Dakota 
Tennessee 
Texas 
Utah 
Vermont 
Virgin Islands 
Virginia 
Washington 
West Virginia 
Wisconsin 
Wyoming 
Yukon Territory 
 Zip/Postal:  
 
 
Country:
 
 
United States of America 
Canada 
Afghanistan 
Albania 
Algeria 
American Samoa 
Andorra 
Angola 
Anguilla 
Antarctica 
Antigua and Barbuda 
Argentina 
Armenia 
Aruba 
Australia 
Austria 
Azerbaijan 
Bahamas 
Bahrain 
Bangladesh 
Barbados 
Belarus 
Belgium 
Belize 
Benin 
Bermuda 
Bhutan 
Bolivia 
Bosnia and Herzegowina 
Botswana 
Bouvet Island 
Brazil 
British Indian Ocean Territory 
Brunei Darussalam 
Bulgaria 
Burkina Faso 
Burundi 
Cambodia 
Cameroon 
Cape Verde 
Cayman Islands 
Central African Republic 
Chad 
Chile 
China 
Christmas Island 
Cocoa (Keeling) Islands 
Colombia 
Comoros 
Congo 
Cook Islands 
Costa Rica 
Cote D'Ivoire 
Croatia 
Cuba 
Cyprus 
Czech Republic 
Denmark 
Djibouti 
Dominica 
Dominican Republic 
East Timor 
Ecuador 
Egypt 
El Salvador 
Equatorial Guinea 
Eritrea 
Estonia 
Ethiopia 
Falkland Islands (Malvinas) 
Faroe Islands 
Fiji 
Finland 
France 
France, Metropolitan 
French Guiana 
French Polynesia 
French Southern Territories 
Gabon 
Gambia 
Georgia 
Germany 
Ghana 
Gibraltar 
Greece 
Greenland 
Grenada 
Guadeloupe 
Guam 
Guatemala 
Guinea 
Guinea-Bissau 
Guyana 
Haiti 
Heard and McDonald Islands 
Honduras 
Hong Kong 
Hungary 
Iceland 
India 
Indonesia 
Iran 
Iraq 
Ireland 
Israel 
Italy 
Jamaica 
Japan 
Jordan 
Kazakhstan 
Kenya 
Kiribati 
Korea, Democratic Peoples Republic of 
Korea, Republic of 
Kuwait 
Kyrgyzstan 
Laos 
Latvia 
Lebanon 
Lesotho 
Liberia 
Libyan Arab Jamahiriya 
Liechtenstein 
Lithuania 
Luxembourg 
Macau 
Macedonia, The Former Yugoslav Republic of 
Madagascar 
Malawi 
Malaysia 
Maldives 
Mali 
Malta 
Marshall Islands 
Martinique 
Mauritania 
Mauritius 
Mayotte 
Mexico 
Micronesia, Federated States Of 
Moldova, Republic of 
Monaco 
Mongolia 
Montserrat 
Morocco 
Mozambique 
Myanmar 
Namibia 
Nauru 
Nepal 
Netherlands 
Netherlands Antilles 
New Caledonia 
New Zealand 
Nicaragua 
Niger 
Nigeria 
Niue 
Norfolk Island 
Northern Mariana Islands 
Norway 
Oman 
Pakistan 
Palau 
Panama 
Papua New Guinea 
Paraguay 
Peru 
Philippines 
Pitcairn 
Poland 
Portugal 
Puerto Rico 
Qatar 
Reunion 
Romania 
Russian Federation 
Rwanda 
Saint Kitts and Nevis 
Saint Lucia 
Saint Vincent and the Grenadines 
Samoa 
San Marino 
Sao Tome and Principe 
Saudi Arabia 
Senegal 
Seychelles 
Sierra Leone 
Singapore 
Slovakia (Slovak Republic) 
Slovenia 
Solomon Islands 
Somalia 
South Africa 
South Georgia and the South Sandwich Islands 
Spain 
Sri Lanka 
St. Helena 
St. Pierre and Miquelon 
Sudan 
Suriname 
Svalbard and Jan Mayen Islands 
Swaziland 
Sweden 
Switzerland 
Syrian Arab Republic 
Taiwan 
Tajikistan 
Tanzania, United Republic of 
Thailand 
Togo 
Tokelau 
Tonga 
Trinidad and Tobago 
Tunisia 
Turkey 
Turkmenistan 
Turks and Caicos Islands 
Tuvalu 
Uganda 
Ukraine 
United Arab Emirates 
United Kingdom 
United States Minor Outlying Islands 
Uruguay 
Uzbekistan 
Vanuatu 
Vatican City State (Holy See) 
Venezuela 
Viet Nam 
Virgin Islands (British) 
Virgin Islands (U.S.) 
Wallis and Futuna Islands 
Western Sahara 
Yemen 
Yugoslavia 
Zaire 
Zambia 
Zimbabwe 
Unknown Country 
 
 
 
How soon would you like to get into your new home?
 
0 - 3 Months 
3 - 6 Months 
6 - 12 Months 
Over A Year 
 
 
 
What style home do you like?
 
One Level 
Split Level 
1 1/2 Story 
2 Story 
3+ Story 
Not Sure/Other 
 Bedrooms:
1 
2 
3 
4 
5+ 
 Bathrooms:
1 
1.5 
2 
2.5 
3+ 
 
 
 
Price range?
 
Less than $100,000 
$100,000-$125,000 
$125,000-$150,000 
$150,000-$175,000 
$175,000-$200,000 
$200,000-$250,000 
$250,000-$300,000 
$300,000-$400,000 
$400,000-$500,000 
$500,000+ 
 
 
 
How many square feet?
 
1,000 or Less 
1000-1500 
1500-2000 
2000-2500 
2500-3000 
3000+ 
Other 
 
 
 
What type of living areas do you want?
 
Living Room 
Great Room 
Den/Family Room 
Recreation Room 
Study/Office 
Basement 
  
(hold control key down for multiple selections)
 
 
What type of dining areas do you want?
 
Eat-in Kitchen 
Kitchen/Dining Combo 
Greatroom/Dining Combo 
Breakfast Room/Nook 
Breakfast Bar 
Dining/LR Combo 
Separate Dining Room 
Dining/LR "L" 
Other 
  
(hold control key down for multiple selections)
 
 
What type of parking do you need?
 
Garage 
Carport 
Driveway 
1 Space Wide 
2 Spaces Wide 
3+ Spaces wide 
Detached 
Other 
  
(hold control key down for multiple selections)
 
 
Would you like to receive property information via our e-mail FLASH  program?
 
 Yes  No 
 Daily  Weekly
 
 
Do you have a bank or mortgage company that you would like to work with?
 
Yes 
No 
 If yes: 
      Company Name:  
      Loan Officer:  
      Phone:  
      Have you contacted them yet? 
Yes 
No 
 
 
 
How did you find us? 
Specifically/Other: 
 
Friend/Family Referral 
Search Engine 
Link 
realtor.com 
REMAX.com 
Montgomery Advertiser 
Tri-County Homes Mag. 
Other 
  
 
 
 
Please tell us about any other features or requests you may have in mind.