Modern Day Realty

Please print (click in this area then hit your print button at the top of your browser),

fill out the requested info, make copies, and give to each of the homebuilders you visit.

Name:____________________________________________________________________________Date:__________________

Name:____________________________________________________________________________

Address:_____________________________________________________________________________________

City:______________________________________________ State:______________ Zip:__________________

Home: _____________________________Cell: _______________________ Cell: _______________________

Work: ________________________________________ Fax: _________________________________________

Email:_______________________________________________________________________________________

Area of Interest: ______________________________________________________

Square Foot: < 1,500    1,500 - 2,000 □   2,000 - 2,500     2,500 - 3000    3,000+

Stories: □ 1 □ 2

Bedrooms: □ 2 □ 3 □ 4 □ 5+

Bathrooms: □1 □ 2 □ 2.5 □ 3 □ 3+

Living Areas: □1 □ 2 □ 3

Time Frame: □ 1-2 months □ 3-4 months □ 5-6 months □ 6-12 months

$100 or less □  $100 - $120 □  $120 - $140  □ $140 - $160       $160 - $180

$180 - $200 □  $200 - $230 □  $230 - $260     $260 - $300 □    $300+

Are you pre-qualified? □ Yes □ No

Comments:______________________________________________________________________

MDR Agent: ____________________________________________Phone:______________________