* Fields are mandatory
*First Name:   State:
*Last Name:   Zip Code:
  Address:   Phone:
  City: *Email:
How would you like to be contacted: Email
  Phone
       Best time to contact you:
 
OPTIONAL FIELDS:
These are optional fields we use to help you find the perfect home.
 
Reason for Move: Price Range:
Relocation
Home Ownership
Retirement
Larger Home
Location
Company Transfer
Under $100,000
$100,000 - $124,999
$125,000 - $149,999
$150,000 - $174,999
$175,000 - $199,999
$200,000 - $249,999
Over $250,000
   
Square Ft. Desired: Floor Plan Style:
Under 1500
1500 - 1999
2000 - 2499
Over 2500
Ranch
2 Story / Master Up
2 Story / Master Down
Multi - Level
Townhome
Any Style
   
Current Housing Status: When would you like to move into a new home:
Renting
Listing
Own
Sold
Other
Immediate
3 - 6 months
6 - 12 months
Over 12 months
 
How did you hear about us?
TV Direct Mail Craigslist.com
Radio Friend/Relative NewHomeGuide.com
Search Engine/Banner Ad Facebook.com Google
Newspaper Twitter.com Yahoo
Sinage Blogger.com Other site
 
Number of bedrooms?
 
2 bedrooms 4 bedrooms
3 bedrooms 5 bedrooms
 
Number of bathrooms?
 
2 bathrooms 3 bathrooms
2.5 bathrooms 3.5 bathrooms
 
Anything else you'd wish to share with us?
 

© 2010 Dan-Ric Homes.
An Equal Opportunity Company. Equal Housing Opportunity.
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800.741.2512
706.882.7773