Name: _______________________________ ____________________________ ____________
Last First Middle
Mailing Address: _____________________________________________________________________
Street Address or PO Box
_____________________________________, _________________________ __________________
City (Town) State Zip Code
Phone # (with area code):
Home ___________________________________ AM PM
Cell ____________________________________ AM PM Best to Contact
Work ____________________________________ AM PM
Fax# if any(with area code): ______________________________________
E-mail Address: ________________________________________________
Physical Address: Same as Mailing OR
_____________________________________________________________________
Street Address
_____________________________________, _________________________ __________________
City (Town) State Zip Code
1. Do you own your physical address? Yes No, Rent
Other (Please Explain) __________________________________________________________
- Is this Purchase: Investment Personal Residence
Other (Please Explain) ______________________________________________________________
- Will Your Funding be: Cash in Full Down Payment (specify %) _____________________
Other (Please Explain) ______________________________________________________________
4. Do you have a Loan Commitment Letter? No Yes, and I am approved for $_______________
Page 2: Client Specific Criteria for Purchase (please print clearly):
5. Total Price Range (including Your Down payment if applies): 100,000-150,000
150,000-200,000 200,000-250,000 250,000-300,000 300,000-350,000
350,000-400,000 400,000 + Your Custom Range _______________ and _______________
Minimum Maximum
No Preference on Price
6. Square Footage: Small-Medium (between 1000 and 2000) Medium-Large (between 2001 and 3000)
Large (Over 3000) Your Custom Range ____________________ and __________________ sq. feet
Minimum Maximum
No Preference on square footage
7. Number of Total Bedrooms (including office): 1-2 2-3 3-4 4 and more
Specify your range____________________ No Preference on number of bedrooms
8. Number of Total Bathrooms: 1-2 2-3 3 and more
Specify your range___________________ No Preference on number of bathrooms
9. Location: No Preference, any High Desert Location Victorville Hesperia Oak Hills
Spring Valley Lake Only Apple Valley Only Silver Lakes Only High Ridge Only
Other, please Specify _________________________________________________________________
10. Other Preferences not Mentioned Above: No other Preferences
Yes, my Preferences are, please specify (i.e. Den, fire place(s), 1or 2 stories, high ceilings, exposure, golf course, waterfront, etc.):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Signature: ______________________________________ Date:___________________________
