Bell & Associates Realty Group
Property Request
Contact Information
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First Name:
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Last Name:
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Email:
Phone:
Address:
City:
State:
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DE
FL
GA
HI
IA
ID
IL
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KY
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MA
MD
ME
MI
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MS
MT
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Zip:
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Working with an agent already ?
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Alonzo Galloway
April Bell
Drew Davis
Fay Tahmassbi
Inger-Lisa Jimenez
Jim Simcoe
Jodi Engles
Kathleen Votsis
Korin Daly
Lindsay Lopez
Lisa Lanza
Lisa Stout
Luke Hoppel
Marty Barhaghi
Michael Bell
Michael Shryock
Mike Rausa
Mike Solorzano
Pamela Kirby
Richard King
Steve Hamilton
Tiffany Lona Shryock
General Information About Your Move
Where are you moving?
State:
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
When do you anticipate purchasing your new home?
select one
within 4 months
within 6 months
within a year
no date set
Information About The Home You Are Looking For
Type of Home:
Single Family
Condo/Townhouse
Multi-family
Mobile Home
Farm
Land Only
Approximately priced between:
select one
$0
$10,000
$20,000
$30,000
$40,000
$45,000
$50,000
$55,000
$60,000
$70,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
$5,000,000
$6,000,000
$8,000,000
$10,000,000
and
select one
$10,000
$20,000
$30,000
$40,000
$45,000
$50,000
$55,000
$60,000
$70,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
$5,000,000
$6,000,000
$8,000,000
$10,000,000
Number of Bedrooms:
select one
1
2
3
4
5
6
Number of Bathrooms:
select one
1
2
3
4+
Interior Features & Preferences:
Living Room
Family Room
Fireplace
Hardwood Floors
Den / Study
Laundry Room
Other Important Interior Features:
Exterior Features & Preferences:
Swimming pool
Spa
Waterfront
Garage
Tile roof
Fenced
Other Important Exterior Features:
Additional Information
Have you ever been pre-qualified for a mortgage?
No
Yes
Do you have a down payment?
No
Yes
Have you had a credit report done lately?
No
Yes
Please use this space for any other comments or questions you might have.
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Michael Bell
760-815-7250
Email Me
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