First Name*

Last Name*

Email Address*

Requested Password*

Street Address*

City*

State* (please select) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP Code*

Phone Number

Is this your: (please select) cell work home

Best time to reach you? (please select) Daytime Evening

How did you hear about us? (please select) broker/realtor search engine sign Colorado Springs Gazette Military Newspaper Woodmen Edition Independent New Falcon Herald Colorado Springs Business Journal radio friend other

Who will be living in your home? (please select) single adult single adult with child(ren) at home 2 or more single adults couple with children couple planning children couple not planning children couple or single adult with children not at home

Your age (head of household)? (please select) 18-24 25-34 35-44 45-54 55-64 65+

Number of children age 0-12 months? () (please select) 1 2 3 4 5 6

Number of children age 1-2? (please select) 1 2 3 4 5 6

Number of children age 3-5? (please select) 1 2 3 4 5 6

Number of children age 6-10? (please select) 1 2 3 4 5 6

Number of children age 11-14? (please select) 1 2 3 4 5 6

Number of children age 15-17? (please select) 1 2 3 4 5 6

Number of children age 18+? (please select) 1 2 3 4 5 6

Your household income? (please select) under $50,000 $50,000 - $75,000 $75,000 - $100,000 $100,000 - $150,000 $150,000+

I/We ... our current home: (please select) Own Rent Just sold Must sell Plan to relocate

When do you hope/want/need
to move? (please select) 0-3 months 3-6 months 6-12 months over 12 months

What's the right price range? (please select) high $100,000 $200,000 - $250,000 $250,000 - $300,000 $300,000 - $350,000 $350,000 - $400,000 $400,000 - $450,000 $450,000+

If you have additional comments, please let us know:

What type of home are you
interested in? (please select) single family home condo duplex townhome apartment custom home site

How many bedrooms would
you like? (please select) 1 2 3 4 5 6

How many garages would
you like? (please select) 1 2 3 4 5 6

What square footage are you
hoping for? (please select) under 1,200 sq. ft. 1,200 - 1,500 sq. ft. 1,500 - 2,000 sq. ft. 2,000 - 2,500 sq. ft. 2,500 - 3,000 sq. ft. over 3,000 sq. ft.

Should your home have a
second floor? (please select) yes no either way is fine

What kind of basement do
you prefer? (please select) standard garden level walkout any none

What is your spouse's name?

Your spouse's age? (please select) 18-24 25-34 35-44 45-54 55-64 65+

What city do you work in?

What is your current commute to and from work each day? (please select) less than 15 minutes 15-30 minutes 30-60 minutes 60 minutes +

Broker/Associate License Number*

Broker/Associate Street Address*

Broker/Associate City*

Broker/Associate State* (please select) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Broker/Associate ZIP Code*

Broker/Associate Phone Number

Brokerage Firm Name*

Brokerage Firm Street Address*

Brokerage Firm City*

Brokerage Firm State* (please select) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Brokerage Firm ZIP Code*

Brokerage Firm Phone Number