Our form looks long, but its simple! Just fill out as much or little as you'd like to tell Mindy-- only the items marked with a "*" are required!

Your Name	*
Phone Number	() -
Work Phone Number	() -
If you can receive information by fax what is the fax number	() -
When is a good time to contact you
Address
City
State
ZIP
E-mail	*

School District
Whose name is the home titled in?
Are you living in the home, is it rented or is it vacant?	Please Select Living in the home Renting the home The home is vacant
How long have you owned this property?	Please Select Less than 1 year 1-3 Years 3-5 Years 5-10 Years 10-20 Years Longer than 20 Years I really don't know
What type of home is it?	Please Select Ranch (1 Story) Cape Cod (1 1/2 Story) 2 Story Bi Level Raised Ranch Split Level Earth Home Condo Duplex Mobile Home Double Wide Modular or Manufactured Other
How many bedrooms are in your house?	Please Select 1 Bedroom 2 Bedrooms 3 Bedrooms 4 Bedrooms 5 or more bedrooms
How many baths?	Please Select 1 1/2 Baths 2 Baths 2 1/2 Baths 3 Baths
What type of exterior do you have?	Please Select Aluminum Brick Stone Vinyl Wood Shingle Stucco Combination Other
What type of foundation do you have?	Please Select Full Basement Partial Basement Crawl Space Concrete Slab Combination Other
What type of heating system you have?	Please Select Natural Gas Furnace Propane Gas Furnace Gas Hot Water Boiler Electric Hot Water Boiler Electric Furnace Electric Baseboard Electric Heat Pump Electric Radiant Heat (in the ceiling) Fuel Oil Furnace Wood Furnace Addon Wood Stove (free standing) Wood Stove (fireplace insert) Fireplace Geothermal Other
What type of air conditioning do you have?	Please Select Central Air Heat Pump Window Air Wall Unit Air Attic Fan Geothermal Other None
What type of garage do you have?	Please Select 1 Car 1 1/2 Car 2 Car 2 1/2 Car 3 Car 3 1/2 Car 4 Car or Larger Pole Barn/Garage Attached Garage Detached Garage Combination Carport Other None
What type of roof do you have?	Please Select Shingle Slate Metal Tile Wood Shakes Combination Other
How many square feet do you have above the basement?	Please Select Under 1,000 Square Feet 1,000 - 1,500 Square Feet 1,500 - 2,000 Square Feet 2,000 - 2,500 Square Feet 2,500 - 3,000 Square Feet 3,000 or more I have no idea
Tell us about any recent improvements or updates that you think will help sell your home:
Have you had the home appraised within the past 5 years?	Yes No
What would you estimate the value of your home to be?
What would happen to your plans if it sold for less than that figured?

Mindy Oberhardt | RE/MAX United
9131 Anson Way, Raleigh, NC 27615
Toll Free (800) 526-7383 | Office (919) 518-8163 | Fax (919) 846-0825

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