Nationwide Referral & Relocation Form

Which state do you intend to move to?  

Which city do you intend to move to?   

Do you have a specific area or preferred location in mind in that city?   

Are you familiar with that area?    Yes   No

Desired price range?   From $   to $

Do you have any VA benefits?   Yes   No

What is your preferred monthly mortgage payment?   $

What would your down payment be?   $

Desired property? (check one)   House   Condominium   Townhouse   Mobile Home   Vacant Land   Commercial   Investment

Desired # of bedrooms? (check one)   1   2   3   4   more

Desired # of bathrooms?(check one)    1   2   3   4   more

Desired garage? (check one)   none   1-car   2-car   more than 2-car

Do you prefer? (check one)   New Construction   Old Construction

Please further describe desired property.  

Do you request any special features?  

How many are in your family?   Adults Children

Tell us about your school requirements?  

Do you currently own or rent?    Own Rent

If you own your current house, did you already list it For Sale?   Yes No

Must you sell your current home before buying in your new location?   Yes  No

What is your reason for moving?  

Is this a corporate transfer?   Yes   No

How can I contact you?

Your first name   Last name

Address:  

City   State   ZIP

Area code   Phone number

E-mail address

What is a good time to call you?  

Date of your first visit to new location (before you move)? Month  Day  Year    

Expected moving date?   Month    Year

Do you have a local contact upon arrival?   Yes  No

If yes, please provide area code  Phone Number