Name:
Home Phone Number:
Work Phone Number:
Cell Phone Number:
E-mail Address:
Where do you live now?
Street Address:
City:
State:
Zip:
Do you "own" your home or rent?
Click to
select Own
Rent
If you rent, when is your lease up?
Are you currently working with an
agent?
Yes
No
How many people will be living in your home?
How soon would you like to be in your new home?
What area(s) would you like to live in?
Click to select Albany Colonie
Latham/Loudonville Guilderland
Delmar Niskayuna Clifton
Park
East Greenbush
Other First Choice
What area(s) would you like to live in?
Click to select Albany Colonie
Latham/Loudonville Guilderland
Delmar Niskayuna Clifton
Park
East Greenbush
Other Additional Choice
If you selected other, please fill in here.
Have you been pre-approved for a
mortgage loan?
Yes
No
What price range are you looking in?
What many bedrooms do you need?
1 Bedroom
2 Bedrooms 3 Bedrooms 4
Bedrooms 5 Bedrooms 6 or more
Bedrooms Click to select
How many bathrooms do you need?
Click to
select 1 Bath 1-1/2 Baths
2 Baths 2-1/2 Baths 3
Baths 3-1/2 Baths 4 Baths or
more
Do you need a garage?
Yes
No
Referred by:
Other specific needs or desired home
features.
What are your concerns about buying
a home?