Please fill out the form below so we may best provide the information you need. Let me represent you in the purchase of your home, contact me today! There is no need for additional cost when you use our service. You may also contact us directly by sending e-mail to homebuy@iag.net

Contact/Information Request Form

Your Name:

Please enter your Address:

Street:	Apt:
City:
State:	Florida Alaska Alabama Arizona Arkansas California Colorado Conetticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New York New Mexico Nevada North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Utah Vermont Virginia Washington Washington D.C. West Virginai Wisconsin Wyoming Not Listed   Zip Code:

Home Phone Number:   

Work Phone Number:   

Fax Number:   

Email Address:   

Current Status: Home Owner: Renting:

Age: Under 24 24 - 34 35 - 44 45 - 54 55 - 64 65+

Income: Under $25,000 $25,000 - $50,000 $50,000 - $75,000 $75,000 - $100,000 $100,000 - $150,000 $150,000+

Interested in home priced from: Under $75,000 $75,000 - $100,000 $100,000 - $150,000 $150,000 - $200,000 $200,000 - $250,000 $250,000 - $350,000 $350,000 - $550,000 $550,000+

Down Payment available: VA 0% 3% 5% 10% 15% 20% +

Desired Monthly payment:

Relocating within: Less than 30 Days 30 to 60 Days 60 to 180 Days 180 to 270 Days Over 270 Days

Employer:

Employer City:

Home Needs: New Home: Resale: Custom:

Square Footage required:

Number of Bedrooms:

Number of Baths:

Formal Living: Formal Dining: Pool:

Number of Garage Stalls:

Desired Location:

Notes:

"If you are serious about buying a home...
we are serious about saving you money."

Call Weldon Harris, C.B.A.
at:
The Buyer's Agent of Central Florida, Inc.
2100 Lee Road
Winter Park, Fl 32789
Phone: (407) 629-5915
Toll Free: (800) 258-5915
Fax: (407) 629-4338

©2000 The Buyer's Agent^SM, Inc., Memphis, TN. Reprinted with permission.

Each office independently owned and operated.