CONTACT INFORMATION
First Name
Last Name
Home Address
City
Unit / Apt #
Province
Email
Postal Code
Contact #
PROPERTY INFORMATION
Primary City
Secondary City
Neighborhood
Price Range	0 $10000 $20000 $30000 $40000 $50000 $60000 $70000 $80000 $90000 $100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $550000 $600000 $650000 $700000 $750000 $800000 $850000 $900000 $950000 $1000000 (Minimum) Unlimited $10000 $20000 $30000 $40000 $50000 $60000 $70000 $80000 $90000 $100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $550000 $600000 $650000 $700000 $750000 $800000 $850000 $900000 $950000 $1000000 (Maximum)
Min Bedrooms	- select here - Any 1 2 3 4 5 6 7 8 9 10
Min Bathrooms	- select here - Any 1 2 3 4 5 6 7 8 9 10
Min. Sq. Feet
How soon do you plan to buy a home?	- select here - Right away Within 3 months Within 6 months Within 1 Year Not Sure
Do you own or rent your home?	- select here - Own Rent
Are you Pre-Qualified?	- select here - Yes No Not Sure
Question, Comment, Feedback,
Agreement:	I agree to provide the right for Peter Zand-Karimi to send me home listings based on the truthfully information I have submitted above.