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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. A builder will contact you as a result of filling out this form. 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
Send me information on BUILDING YOUR OWN HOME WITH NO DOWN PAYMENT AND LESS THAN $1,000 OUT OF POCKET.
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

Used Laptops

The Location in which you will be Building (Very Important)
Telephone Area Code (example: 770)
Town
County
State
I am a....
Type of Building that I am Most Interested in
Price Range (Not Including Lot)
Lot Requirement (Please Answer)
I have a Lot to build on.
I need to get a Lot.
Stories
Number of Bedrooms
Basement
Number of Bathrooms
Garage
Master Bedroom on First Floor Yes No
Special Needs
Home Office Needs
Number of Children
School Needs
How Did You Find This Web Site?
Search Engine
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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