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*First Name:
*Last Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Fax:
*Email:

When will you be in the market to build a home?
Immediately    3-6 Months    6-12 Months    1 Year +

What price range fits your budget?
$150,000 - $200,000    $200,000 - $250,000    $250,000 - $300,000    Over $300,000

I am interested in building in:

What size home are you interested in?
# Of Bedrooms:
3    4    4+

# Of Bathrooms:
2    3    3+

# Car Garage:
2    3

Den/Computer Room?
Yes    No

Swimming Pool
Yes    No

Do you currently own a lot you would like to build on?
Yes    No

Other Features?

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