Name
Street Address
City State Zip
E-mail
Phone Number (Home)
Phone Number (Work)

Presently I...

Own a home

Rent

Other

I am interested in:

2 Bed

3 Bed

4 Bed

5 Bed

In a park

Own land

Need land

I would like assistance with financing?

Yes

No

If no, are you a cash buyer?

Yes

No

Pre-approved?

Yes

No

Someone I know who wants a home of their own:
Name Phone

I, or someone I know, live in a manufactured home:

Yes

No

How did you hear about us?

Additional comments / info: