Home Buyer Information Form

Please fill in the following information so that we can route your request to a builder in your area who will assist you. We look forward to working with you!

Your Last Name (required) Your First Name(s)

E-mail address (required) (example: myuserid@mindspring.com)

Please include me on your Email List for              (required) Bulletins, Newsletters, Updates, and Referrals    Yes           No

Home Telephone Number (example: 770-555-1212)

Business Telephone Number (example: 912-555-1212)

Fax number (example: 404-555-1212)

Mailing Address Street City State (Abrv.) Zip Code

The Location in which you will be Building (Very Important) Telephone Area Code (example: 770) Town County State

I am a.... ... Single Home Buyer Builder / Developer Home Manufacturer Dealer

Type of Building that I am Most Interested in ... A-Frame Colonial Contemporary Cape Cod Traditional Single Family Cluster Home Commercial Condominium Townhouse

Price Range ... $0 - $50,000 $50,000 - $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 - $350,000 $350,000 - $499,999 $500,000 and above (Not Including Lot)

Lot Requirement (Please Answer) I have a Lot to build on. I need to get a Lot.

Stories ... 1 2 3 Split-level Split-foyer

Number of Bedrooms ... 1 2 3 4 5 or more

Basement ... Finished basement with Bath Home office Exterior entrance Crawl space

Number of Bathrooms ... 1 1-1/2 2 2-1/2 3 or more

Garage ... 1 car 2 cars 2+ cars With workshop/toolshop

Master Bedroom on First Floor Yes No

Special Needs ... ADA Accessibility Alarm System Golf course Country Club Swim/Tennis Jogging Cycling Walking Hiking

Home Office Needs ... ISDN Cable Modem T1 line T3 line Wireless Communications Multiple phone lines Satellite Reception Parking Alarm System

Number of Children ... 1 2 3 4 or more

School Needs ... Public elementary school Public middle school Public high school Private elementary school Private middle school Private high school Public college/university Private college/university

How Did You Find This Web Site?

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Other

Questions? Comments? Suggestions? List any homes that you may be interested in.

Phone Number Please send me your phone number so I can call The Modular Network.

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