Home Buyer Information Form

Please fill in the following information so that we can route your request to a builder in your area who will assist you. A builder will contact you as a result of filling out this form. We look forward to working with you!

Your Last Name (required) Your First Name(s)

E-mail address (required) (example: myuserid@mindspring.com)

Please include me on your Email List for              (required) Bulletins, Newsletters, Updates, and Referrals    Yes           No

Send me information on BUILDING YOUR OWN HOME WITH NO DOWN PAYMENT AND LESS THAN $1,000 OUT OF POCKET.

Home Telephone Number (example: 770-555-1212)

Business Telephone Number (example: 912-555-1212)

Fax number (example: 404-555-1212)

Mailing Address Street City State (Abrv.) Zip Code

The Location in which you will be Building (Very Important) Telephone Area Code (example: 770) Town County State

I am a.... ... Single Home Buyer Builder / Developer Home Manufacturer Dealer

Type of Building that I am Most Interested in ... A-Frame Colonial Contemporary Cape Cod Traditional Single Family Cluster Home Commercial Condominium Townhouse

Price Range ... $0 - $50,000 $50,000 - $100,000 $100,000 - $125,000 $125,000 - $150,000 $150,000 - $175,000 $175,000 - $200,000 $200,000 - $250,000 $250,000 - $300,000 $300,000 - $350,000 $350,000 - $499,999 $500,000 and above (Not Including Lot)

Lot Requirement (Please Answer) I have a Lot to build on. I need to get a Lot.

Stories ... 1 2 3 Split-level Split-foyer

Number of Bedrooms ... 1 2 3 4 5 or more

Basement ... Finished basement with Bath Home office Exterior entrance Crawl space

Number of Bathrooms ... 1 1-1/2 2 2-1/2 3 or more

Garage ... 1 car 2 cars 2+ cars With workshop/toolshop

Master Bedroom on First Floor Yes No

Special Needs ... ADA Accessibility Alarm System Golf course Country Club Swim/Tennis Jogging Cycling Walking Hiking

Home Office Needs ... ISDN Cable Modem T1 line T3 line Wireless Communications Multiple phone lines Satellite Reception Parking Alarm System

Number of Children ... 1 2 3 4 or more

School Needs ... Public elementary school Public middle school Public high school Private elementary school Private middle school Private high school Public college/university Private college/university

How Did You Find This Web Site?

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Other

Questions? Comments? Suggestions? List any homes that you may be interested in.

Phone Number Please send me your phone number so I can call The Modular Network.

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