* Required Fields 

Your Name (First, Last):*
Address: *
City: *
State: *
Zip/Postal Code: *
Email: *
Phone: *
Fax:
Please give us the details of the home you wish to sell:
Neighborhood or Development:
Primary Residence or Other: *	Choose One Primary Residence Secondary Residence Vacation Home Rental
Relationship with Property: *	Choose One Legal Owner Renter Landlord Property Manager Potential Buyer Other
Type of Property: *	Choose One Single Family Home Multiple Family Home Townhouse Condominium Manufactured Home Mobile Home
Style: (single story, ranch, split level, etc)
Square Footage:*                                   (Only heated and cooled)
Approximate Year Built:
Lot Size/Acreage: *	Choose One City Lot 1/2 Acre 1 Acre 2-5 Acres 5-10 Acres 10+ Acres Unsure
Type of Heating:
Number of Bedrooms:  *
Number of Bathrooms:  *
Parking: *	Choose One Garage Carport On Street Off Street No Covered Parking
Spaces: *	Choose One None 1 Car 2 Cars 3 Cars More than 3
Pool:	Yes No
Fireplace:	Yes No
Basement: Finished?	Yes No Yes No
On a scale of 1 to 10 (1 being Poor and 10 being Exceptional) please rate the showability of your home: Poor 110 Exceptional
Special Features:
When are you planning to sell?*	Choose One Right Away Within 90 Days Within 6 Months Within 12 Months
Where will you be moving to?
Is your home currently listed?*	Choose One Not Currently Listed For Sale by Owner Yes - With an Agent
How did you hear about me?*	Choose One Search Engine Online Banner Ad Referral from Friend Newspaper Ad Postcard Internet Sign Other
Add Me to Your Mailing List     All information submitted will remain strictly confidential and will not be distributed or sold by Florida-Relocator.com. * MIP insurance is suppose to be based on 80% loan to value. Your mortgage company may require you to obtain an appraisal in addition to a Market analysis.