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First Name Last Name   Address 1 Address 2 City State Zip   Email Home Phone Work Phone Cell Phone Fax     How did you hear about Farmstead   Billboard Mail Newspaper Magazine Property Owner Realtor Real Estate Show Relative/Friend Internet Search Engine Internet Home Listing Service Other If Other, please specify Were you referred by someone   Yes No If yes, by whom How did you find our website   Ad Brochure Alta Vista AOL Excite Google Yahoo Other Search Engine City Guide Link Friend Other If Other, please specify Have you visited Farmstead before   Yes No Have you received information from Farmstead   Yes No If yes, from whom Area of Interest   Homesite Patio Home Condominium Price Range   $99,000 - $190,000 $195,000 - $225,000 $225,000 - $275,000 $275,000 - $300,000 Intended use of property   Permanent Seasonal Future Investment Preferred view   Wooded Pond/Lake No Preference Anticipated timeframe to visit   within 3 months 3 to 6 months 6 to 12 months Anticipated timeframe to purchase   within 3 months 3 to 6 months 6 to 12 months   Additional Comments