Name:

Phone Number:

E-mail:

Verify E-mail:

Current Street Address:

City:

State:

AK AL AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX VA VI VT WA WI WV WY

Zip Code:

Time Frame in which I look to purchase a home:

Within the next 30 days Within 30 to 90 days Over 90 Days From

I am interested in a home in the following areas: (check all that apply)

Washington, DC:

Georgetown

Wesley Heights

Kent

Foxhall

Palisades

Cleveland Park

American University

Spring Valley

Berkeley

Glover Park

Dupont Circle

Chevy Chase

Capitol Hill

Logan Circle

Mount Pleasant

Forest Hills

Adams Morgan

Woodley

Montgomery County, MD

Bethesda/Chevy Chase

Potomac/Rockville

Silver Spring/Wheaton

Arlington County/Alexandria City, VA:

North Arlington

South Alington

Alexandria

Fairfax County, VA:

Centreville/Chantilly

Great Falls/McLean

Dulles Area/Herndon

Reston

Vienna/Oakton

Falls Church/Annandale

Fairfax/Clifton

Burke/Clifton

Mt. Vernon/Lorton

Loudon County, VA:

Middleburg

Leesburg/Purcellville

Sterling/Ashburn

Delaware:

Rehobeth

Lewes

Colonial

Split Level

Contemporary

Townhouse

Split Level

Rambler

Condo

Custom

Farm/Victorian

Tudor

Estate

Other

Price Range:

Less than $100,000 $100,000-$125,000 $125,000-$150,000 $150,000-$175,000 $175,000-$200,000 $200,000-$225,000 $225,000-$250,000 $250,000-$300,000 $300,000-$350,000 $350,000-$400,000 $400,000-$450,000 $450,000-$500,000 $500,000-$750,000 $750,000-$1,00,000 $1,000,000 and higher

Age of House:

New 1-5 Years 6-10 Years 11-20 Years 20-50 Years Over 50 Years

# Bedrooms:

1 2 3 4 5 6 7 Other

# Bathrooms:

1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 Other

# Garages:

1 2 3 or more none

Other Rooms (check left column if necessary, right if you would prefer to have said room):

Recreation Room

Library/Study

Billiard, Media Room

Nanny/In-Law Suite

Butler Room/Pantry

Wet Bar

Basement

Skylight

Deck

Eat-In Kitchen

In-Law Suite

Fireplace

Do you have a home for sale?

No Yes, but it is not listed Yes and it is listed

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