Name Present Address Spouse Name Number of Children Home Telephone Office Telephone Fax Email Address Price Range No. Of Bedrooms 3 Bedrooms 4 Bedrooms 5 Bedrooms 6 Bedrooms 7 Bedrooms 8 Bedrooms 9 Bedrooms More Than 9 No. Of Bathrooms 2 Bathrooms 3 Bathrooms 4 Bathrooms More Than 4 Preferred Area Arlington Avery Dublin Gahanna Grandview Granville Hilliard Marysville Metro Columbus Muirfield New Albany Polaris Westerville Worthington School district preference Preferred date of move What are the most important amenities for you? What do you definitely NOT want in your home? NO YES Have you already looked at homes in the area? NO YES Have you been working with a realtor? NO YES Have you talked with a lender? Additional Comments: If you have problems submitting the form, send email to rosemary@wreathall.com

Design and Graphics Copyright © 1999 by dhatlee@dhpc.com