BUYERS FORM

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Text Only Version of this form.

Please fill out all the necessary data below,
so Derek & Debra Kirk can provide you with the accurate information you need.

INFORMATION ABOUT YOURSELF

FIRST NAME:

LAST NAME:

STREET:

CITY:

STATE:

ZIP CODE:

DAY PHONE:

(Please include area code)		 EVENING PHONE:

(Please include area code)		 FAX:

(Please include area code)
E-MAIL:

HOME BUYING INFORMATION

PREFERRED CITY(s) TO PURCHASE HOME?



PREFERRED ZIP CODE AREA(s)?
PREFERRED ACREAGE SIZE:

PREFERRED STORIES
 PREFERRED SQUARE FOOTAGE
 PREFERRED BEDROOMS
 PREFERRED BATHROOMS
PREFERRED FIREPLACE(S)
 PREFERRED TYPE
 PREFERRED GARAGE


OPTIONAL ITEMS
ABOVE-GROUND POOL?
 HOT TUB?
 AGE OF HOME?
BUILT-IN POOL
 GAZEBO
 LOCATION OF HOME


ADDITIONAL PREFERRED ITEMS


ARE YOU PREQUALIFIED?
 IF NOT, NEED HELP FINDING A LENDER
COMMENTS



DEREK'S
ACCOMPLISHMENTS!
WHY LIST WITH
DEREK & DEBRA KIRK?
TESTIMONIALS
NOT READY TO
BUY OR SELL?

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Web site last modified in September 2010