FROM:    First Name:   (required)
                                      Last Name:  (required)
                                Email address:  (required)

                    Type of Home:  A single-family home A condominium

                    Price range: Under $100,000 $100,000 - $150,000 $150,000 - $200,000 $200,000 - 250,000 $250,000 - $300,000 $300,000 - $350,000 $350,000 - $400,000 $400,000 - $500,000 $500,000 - $600,000 Over $600,000

             Minimum number of Bedrooms: 1 2 3 4 5 6 or more

            Minimum number of Bathrooms: 1 2 3 4 5 6 or more

            Minimum square footage:

                    I am primarily interested in: Gulf Front Gulf Access Bayou Front Lagoon front Intracoastal Waterway access River or Lake Front Any waterfront Close to the beach A great view On a golf course Other

                           ADDITIONAL DETAILS: (garages, boathouse, pool, etc.)
                   

                    I NEED A RESPONSE: Immediately within 24 hours within 3 days within 5 days

                    PLEASE CONTACT ME BY Email Phone Fax   phone:

                    The best time to call is: Daytime Evening    fax number: 

                    I plan to buy within: weeks a month 2 months 3 to 5 months Just thinking about making a change...

                    If you need to mail me a package, my address is:

                     street (and apt. no.)

                     city/town:  state/Prov.

                     country:                 Post,/Zip Code:

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