Purchase Intake Form

Form
Date
MonthDayYear
Date
Name
First NameLast Name
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com

Rent/ Own__________________How Long_________________Primary Residence___________________ Property Seeking : SFH/ Condo/ Town/ Other________________________________________________
Location_______________________________________________________________________________________
Time Frame__________________________Percentage Financing__________________________________
Cash Available________________________________________________________________________________
Present Employer____________________________________________________Phone__________________
Position__________________________________Mthly Income_______________________________________
Number & Type of Pets__________________________________ 55 years old _________/_____________
Total Number of Children Living with You Under the Age of 18 _______________________________
What Days & Times Are You Available to See Properties______________________________________

Kawtar Fouad Contact Me at : (954)240-6062
Premier Associate Realty
Realtor
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