For Information and Online RELOCATION PACKAGE,
please fill in this brief Profile & Preference Form.

CUSTOMER INFORMATION

Name(s):
Organization/Employer:
Rank (if Military):
Home Phone # (incl. area code):
Work Phone # (incl. area code):
Fax # (incl. area code):
E-Mail Address:
Mailing Address:

City, State, Zip:
Number of Family in Home:
Approximate Move Date:
Approximate Visit Date:
Do You Have a Home
to Sell First?:

CUSTOMER PREFERENCES

What are your real estate needs?: Buy Sell Lease Undecided

Would you like to receive our online Relocation Package?: Yes No

Would you like to be "Pre-Qualified" by a Lender?: Yes No

Price Range:

Monthy Payment Range:

Number of Bedrooms:

Number of Bathrooms:

Approx. Sq. Footage:

Comments or Special Needs:

 


3631 Maplewood Ave., Suite 1, Wichita Falls, Tx 76308
940-692-8120 & Fax 940-691-1213
Toll Free 1-800-288-9828
E-mail via dsteed@hirschirealtors.com
Thank You for visiting http://www.hirschirealtors.com