name

Personal Information:
Name: (Required)
E-mail: (Required)
Address:
City:	State:		Zip:
Day telephone:
Evening telephone:
General information about your move:
Are you relocating?		Yes No
Where are you moving?
When do you anticipate purchasing your new home?
Information about the home you are looking for:
Type of home:		Single Family Condo Farm		Multi-Family Mobil Home Land only
Approximately priced between:
and
Minimum Number of bedrooms		or more
Minimum Number of bathrooms:		or more
List any other details you want in a home:
Additional Information:
Have you been pre-approved or pre-qualified for a mortgage?		Yes No
If yes, for how much?
Do you have a down payment?		Yes No
If yes, what is your maximum commitment?
Have you had a credit report done lately?		Yes No
If yes, any problems?		Yes No
Please use this space for any other comments or questions you might have.
Realtor you would like to respond:

Click here to view a required disclosure form directly from the State of Maine's Real Estate Commission: