| Contact Information |
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| First Name: |
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| Last Name: |
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| Email Address: |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Phone: |
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| Fax Number: |
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| Best time to contact you: |
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| Do you have children? |
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| If yes, what are their ages? |
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| How can I assist you? |
| I/we are considering selling our home in New Jersey. |
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| If yes, would you be interested in my providing you with a market analysis of your home and marketing proposal, at no cost or obligation to you? |
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| {movingto title} |
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| What will you be looking for in a new home? |
| Type of Home |
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| Minimum Number of Bedrooms |
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| Minimum Number of Baths |
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| Type of Neighborhood |
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| Every home and community are different. Please use this next area to give me specific feedback about your ideal home or location that you think will be helpful: hobbies in your home, home office, formal dining or living rooms, eat-in kitchen, traditional |
| Ideal Home Characteristics |
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| Financing |
| Will you need to sell an existing property to purchase this home? |
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| Will you need to obtain financing, or will this be a cash transaction? |
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| If you are financing, how much cash will you have for downpayment and closing costs? (approximately) |
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| Please use the area below to provide any information about financing which you think will be helpful: |
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| Information you would like to receive |
| Relocation Package (includes a detailed report on local schools) |
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| How would you like the Relocation Package sent? |
{endhow value} |
| Would you like to receive my monthly e-Newsletter? |
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| Contact information on local lenders (sent by E-Mail) |
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= Required |
