Derek Kirk

SELLERS FORM

If your Browser does not support tables and forms, please go to the
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 SELLING INFORMATION

ADDRESS OF HOME TO BE SOLD

STREET:

CITY:

STATE:

ZIP CODE:

YEAR BUILT

BUILDER

STORIES
APPROX. SQUARE FOOTAGE
BEDROOMS
BATHROOMS
GARAGE STYLE

HEAT
(select up to 4)
Central Heat
Electric Heat
Fireplace Insert
Floor Furnace
Heat Pump
Multi-Units
Natural Gas
Pellet Stove
Propane Heat
Propane Stove
Solar/Partial
Wall Furnace
Wood Stove
other

AIR
(Select up to 4)
Attic Fan
Central A/C
Evaporative Cooler
Heat Pump
Multi-Units
No A/C
Refrig Wall Unit
Whole House Fan
Window A/C

ENERGY FEATURES
(select up to 5)
Dual Pane Full
Dual Pane Partial
Ceiling Fan(s)
Plumbed for Solar
Solar Heating
Solar Screens
Storm Windows
other

FIREPLACES

FIREPLACE (Select up to 5)
Circulating
Double Sided
In Family Room
Gas Burning Log
Insert
In Living Room
In Master Suite
Piped Gas
other

OTHER INTERIOR EXTRA'S

APPROX. ACREAGE

TYPE

SITE LOCATION

HOME
OWNER ASSOC.

EXTERIOR
(select up to 3)
Brick
Brick Veneer
Shingle
Siding-Lap
Siding-Metal
Siding-Vinyl
Stone
Stucco
Wood
other

ROOF DESCRIPTION
(select up to 3)
Comp Shingle
Flat/Low Pitch
Metal
Rock
Shake
Skylight
Slate
Tar & Gravel
Tile
Wood Shingle

FOUNDATION
(select up to 2)
Concrete Slab
Not on Foundation
Raised Foundation

RECREATIONAL PARKING
(select up to 3)
Boat Dock
Boat Storage
Plane Port
RV Access
RV Possible
RV Restrictions
RV Storage

POOL

IF YES, POOL TYPE
(select up to 4)
Above Ground
Built-In
Built-In SPA/Hot Tub
Community Pool
Fenced
Gunite Construction
Heated
Lap
Personal SPA/Hot Tub
Sport Pool
Vinyl Liner
Solar Heated
other

LANDSCAPE
(select up to 5)
Auto Sprinkler Front
Auto Sprinkler Rear
Sprinkler Front
Sprinkler Rear
Back Landscaped
Front Landscaped
Dog run
Fenced Back
Fenced Front
Low Maintenance
Maintenance
.....Provided

MISCELLANEOUS
(select up to 6)
Covered Patio
Deck(s)
Electric Gate
Enclosed Patio
Gated Community
Gazebo
Patio
Public Transport
Security Sys Leased
Security Sys Owned
Underground Tank
Window Furnishings
Wet Bar

OTHER STRUCTURES
(select up to 2)
Greenhouse
Guesthouse
Tool Shed
Workshop
Out Building

SCHOOL DISTRICT

OVERALL CONDITION?

LOOKING TO BUY? RENT? OR RELOCATE?
BRIEF EXPLANATION

OR SUBMIT DETAILED INFORMATION ON
BUYERS INFORMATION FORM

COMMENTS

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

Webmaster - Armstrong Creations
Web site last modified in January 2011