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NAME
EMAIL
PHONE
CELL
CURRENT ADDRESS
WHAT IS YOUR
TIME FRAME?
Immediately
Start in 3 months
Start in 6 months
Start in a year
Still in the planning stage
SUBDIVISION
LOT #
TYPE OF HOME
Bungalow
Conventional
Craftsman
Log Home
Log Siding
Old World
Other
If Other:
HOUSE PLAN?
Yes
No
BASEMENT?
Yes
No
SQUARE FOOTAGE
NOTES
PREFERRED CONTACT METHOD
Home Phone
Cell Phone
Email
PREFERRED CONTACT TIME
(if by phone)
Before Noon
Between Noon & 5p
After 5p
All times Eastern
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