Your E-mail address (required):

Your phone number:
Your fax number:

Your mailing address:

How would you prefer to be contacted? Choose one by phone by e-mail by fax

What is the best time to reach you? (Central Time): Choose one mornings afternoons evenings

Do you have a home to sell? Yes

When do you plan to buy? Choose one Less than 90 Days 3 months - 6 months 6 months - 1 year More than 1 year No Plans to Buy

How many bedrooms do you prefer? Choose one 2 3 4 5 or more

How many bathrooms? Choose one 1 1.5 2 2.5 3 or more

What is your price range? Choose one under 50,000 50,000-65,000 65,000-80,000 80,000-90,000 90,000-100,000 100,000-110,000 110,000-120,000 120,000-130,000 130,000-140,000 140,000-150,000 150,000-175,000 175,000-200,000 200,000-225,000 225,000-250,000 275,000-300,000 300,000-350,000 350,000-400,000 450,000-500,000 over 500,000

What would you like to be your down payment? Choose one under 5 percent 5 to 10 percent 10 to 15 percent 15 to 20 percent over 20 percent

Would you like to receive mortgage information
and current interest rates? Yes

What style of home do you prefer?
(multiple items may be chosen)

Condominium Townhouse Zero-lot line
Single Family Home Acreage No preference

What town or towns would you prefer to live in?

Iowa City Coralville North Liberty Tiffin Hills
West Branch Lone Tree Riverside Solon
University Heights No preference

Another area not listed

Use this space for any additional
information about your specific needs.