Have you had contact with any other Exit Success Realty Agent?  No Yes   
                If so When was the last date of contact? 

        Please Enter Your Full Name, Street Address, Phone Numbers

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country (If other than USA.
Home Phone
Work Phone
Email Address

         What is the best time to contact you?  

                        Day      Evening     Time: 

        Are you looking to:  

                           Buy Sell Rent

        Buying or Selling?  ---  Price Range Desired

                          $60K to $69K $70K to $79K $80K to $89K $90K to $99K $100K to $124K $125K to $149K $150K to $200K $200K or Greater

        When do you plan to move?  

                        0 to 3 Months 3 - 6 Months 6-9 Months 9-12 Months Greater than 12 Months

        Type Property:  

                        Residential Residential (Land Only) Commercial Commercial (Land only) Land (Other)

        Property will be used for: 

                         Residence     Commercial     Investment

       What are some of the requirements for purchasing a home?

                 (Example: 3 Bedroom, 2 Baths, 2 Car Garage, Close to High School South Houston County) 

        Do you plan to visit this area?              If so when? (Date)

        Reason for Relocation 

            Larry Hathaway