Name:
Email Address:
Telephone:
Price Range:	$1,000-$10,000 $11,000-$20,000 $21,000-$40,000 $41,000-60,000 $61,000-Higher
Age:	Under 21 21-54 55-Over
Number of Bedrooms desired:
Number of Baths desired:
Do you prefer a park with a pool?	Yes No
Do you have a pet?	Yes No
Weight of pet:
Will children be living in new home?	Yes No
Preference for lot rent to be paid:	$300-$399 $400-$499 $500-Higher