---

 

First Name:*
Last Name:*
E-mail Address:*
Current Address:
City:
State:	select AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Country:	United States Canada ---------------- Albania Algeria American Samoa Angola Anguilla Antarctica Antigua Argentina Armenia Aruba Australia Austria Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Bermuda Bolivia Brazil British Virgin Islands Bulgaria Cambodia Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Ethiopia Falkland Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya North Korea South Korea Kuwait Laos Latvia Lebanon Liberia Libya Liechtenstein Lithuania Luxembourg Former Republic of Macedonia Madagascar Malaysia Mali Malta Marshall Islands Martinique Mexico Monaco Mongolia Monserrat Morocco Mozambique Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norfolk Island Northern Mariana Islands Norway Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent Samoa Saudi Arabia Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka St. Helena Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tanzania Thailand Tonga Trinidad and Tobago Tunisia Turkey Turks and Caicos Islands Tuvalu U.S. Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom Uruguay Vatican City Venezuela Vietnam US VIrgin Islands Yemen Yugoslavia (former) Zaire Zambia Zimbabwe
Zip Code:
Home Phone:*
Daytime Phone:*
Cell Phone:

---

Have you been working with a realtor?

Yes No

---

Wish List:

# of Bedrooms:

1 2 3 4 5

# of Bathrooms:

1 2 3 4 5

Square Footage:

---

Area of Town:	Central Houston: Bellaire Downtown Medical Center Midtown Montrose Old 6th Ward	Rice Military River Oaks South Hampton The Heights West University
	Southwest Houston: Bunker Hill Village Katy Meadows Missouri City	Richmond Rosenberg Stafford Sugar Land

---

School Preference:

---

Type of Home:

Single Family Home Condominium Duplex Patio Home Townhome Loft

---

Price Range:

$150,000 - $200,000 $200,000 - $250,000 $250,000 - $300,000 $300,000 - $350,000 $350,000 - $400,000 $400,000 - $450,000 $450,000 - $500,000 $500,000 - $550,000 $550,000 - $600,000 $600,000 - $650,000 $650,000 - $700,000 $700,000 - $750,000 $750,000 - $800,000 $800,000 - $850,000 $850,000 - $900,000 $900,000 - $950,000 $950,000 - $1,000,000 $1,000,000 - $2,000,000 $2,000,000 Plus

---

Is your loan pre-approved?

Yes No

---

Time Frame:

Now 3-6 Months 1 Year 1 Year Plus

---

Additional Comments:

---