First Name*

Last Name*

Address*

Address Cont'd

City*

State* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginaWisconsinWyoming

Zip Code*

Telephone*

Email

Best Time To Call

Type of House Type of HouseCraftsman RanchCraftsman 2 StoryRanchTwo StoryCape CodOtherRemodel

Budget BudgetUnder $100,000$100-$120,000$120-$140,000$140-$160,000$160-$180,000$180-$200,000$200-$250,000$250-$300,000$300-$350,000$350-$400,000$400-$450,000$450-$500,000$500-$600,000$600-$700,000$700-$800,000$800,000+

Time Frame to Build Time Frame to BuildImmediately1-3 Months3-6 Months6-12 MonthsMore than 12 Months

Square Footage

What Search Engine Did you Use? What Search Engine Did you Use?All the WebAlta VistaAmerican Home Guides.comAOLAsk JeevesDirect HitExciteGoogleHome-Builder.comiNestLycosMSNNorthern LightOtherOvertureWebCrawlerYahoo

Status of Present Residence? Status of Present Residence?RentingHome Doesn't Need Sold FirstHome Needs to be SoldHome Currently for SaleTransferring to AreaHome Already Sold

Desired County to Build? Desired County to Build?BooneClintonHamiltonHendricksHowardJohnsonMadisonMarionMorganOtherPutnamTippecanoe

Do You Own a Lot? Do You Own a Lot?YesNoNo, but I have some in mind

Where Did you Hear About Us? Where Did you Hear About Us?WebsiteHome ShowCustomer ReferralRealtor ReferralDirectional SignsFlyerOther

Who?

How Did You Hear About Us?