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Desired Property Type:*	choose Apartment Duplex Condominium House Multiplex Townhouse Acerage Farm
No. of Desired Bedrooms:*	choose 1 2 3 4 5 6 7 8
No. of Desired Bathrooms:*	choose 1 2 3 4 5
Desired Location/Area:*	choose Brockville City Brockville Perimeter Maitland Prescott St. Lawrence Waterfront Other/Unknown
Desired Style of Home*:	choose Bungalow 2 Storey Split Level Semi-Detached Condo Other/Unknown
Desired Price Range:*	choose up to $100,000 $100,000 - $150,000 $150,000 - $200,000 $200,000 - $250,000 $250,000 - $300,000 $350,000 - $400,000 $400,000 - $500,000 $500,000 +
Timing of Move:*	choose Immediately Within Next 3 months Within Next 6 months Within Next 12 months More than 1 year from now Not Sure / Other
Do you need to sell your present home?:	- Yes No
If so, are you currently working with an agent to sell your home?:	- Yes No
Have you been pre-qualified for a new mortgage?:	- Yes No
Your Full Name:*
Your Email:*
Your Tel. No.:*
Your Mobile. No.:
Your Current Address:
Any Questions or Special Requests:
Please Send Me A FREE Buyers Package:	Yes Please!    No Thanks
Please Send Me A FREE Brockville Info Package:	Yes Please!    No Thanks
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