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GENERAL INFORMATION

First Name            
Last Name
Address
 City
State or Province
 Zip Code        Country
   
Home Phone
Area Code Number 		Work Phone
Area Code Number
Fax Number
Area Code Number 		Best Times to Call
E-Mail Address
 Spouse Name

HOME PREFERENCES

Do You Currently Own a Home?

Yes No 		If Yes, What is the Status of Your Current Home?
I Am Looking for Property to be Used as...
What Style of Home Do You Prefer?     
Minimum Number of Bedrooms?
 1  2  3  4  5+ 		Minimum Number of Bathrooms?
1  2  3  4  5+
Approximate Price of Home?
From   To 		Areas of Miami Desired? See Map
(Hold CTRL to select as many as apply)
How Do You Plan To Pay For Your Purchase?
 What Percentage of Mortgage Would You be Looking to Secure?

Desired Exterior Features? (check as many as apply)

Swimming Pool               Yes No

Horses Allowed    Yes No

Waterfront                     Yes No

Tennis Court        Yes No
Property With Acreage Yes No Garage                 Yes No
Other Features:
Other Considerations:
How Did You Hear About This Web Site?


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Esslinger-Wooten-Maxwell, Inc.
        
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