Southwest Florida Properties - Home & Condo Buyer Information Form

Betty Prokos
Century 21 Sunbelt, Inc.
101 Taylor Rd.
Punta Gorda, Fl. 33950
Toll-Free Line: 800- 749-7591
Local: 941-255-9144 / Fax: (509) 752-0810
Email: betty@swfloridaproperties.net

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Your Contact Information:

*required information

*Name:

*Address:

Address Line 2:

*City:

*State/Province:

*Country:

*Zip/Postal Code:

(no dashes or spaces)

*Day Telephone:

(no dashes or spaces)

Evening Telephone:

(no dashes or spaces)

*Email Address:

*How do you prefer to be contacted?

Day telephone
Evening telephone
Email

What Type of Property Are You Looking For?

Lot Size/Acreage:

*Property Type:

Approximate Square Footage:

*Number of Bedrooms:

*Number of Full Bathrooms:

*Swimming Pool:

Yes
No

Garage Size:

*Maximum purchase amount:

Where are you moving from?

Have you listed your current home for sale?

Yes
No
Prefer not to say

Will you be applying for a mortgage?

Yes
No
Prefer not to say

Have you been approved for a mortgage?

Yes
No
Prefer not to say

*Would you like to receive property information from the agent?

Yes
No

How did you hear about us?

Comments or Questions:

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