Name:

Address:   

City:  

Postal Code:

FAX: Phone: E-Mail:    

If you could live anywhere where would it be?

Why?

We Have Decided to move to the area.

We Are Looking For Information about a number of communities

I asked about Cobourg because .....

2 things I want my  new community to have...

I want my community to give me......

I have family close by  YES  NO

Where?

How long have you been looking ?

Are you working with another agent? YES  NO

I own my home  YES     or   I am currently renting  YES

Do you need to sell before I buy?  YES  NO

My Price Range Is ....

Have you seen any homes that you really like?  YES  NO

If yes, why didn't you buy?

If we find the right property,are you prepared to
make a decision at that time?  NO   YES

How soon do you need to move ?

Is there anyone else who's helping you make this decision ?
  NO  YES

Special requirements in my new home?

 
 I  prefer....  Mornings  Evenings

My  hobbies .......

Is gardening important me ..  NO    YES

My favorite social activites ....

Something I've always wanted to do .....

3 things in a home I can't live without are ... 

Collections I want to have room for...

 
I would like to have .....
bedrooms     bathrooms
square footage 

Are stairs a concern in the future?  YES  NO

Is a garage a priority?  YES  NO

Are there any pieces of furniture you hope to bring with you?
Size?

Do you have a REALTOR now working for you at home?
  YES  NO
 

Do you have any specific questions, concerns or interests ?