INFORMATION REQUEST FORM

What area are you interested in purchasing real estate?
    Washington Chocowinity Bath Belhaven Pantego Pinetown

What type of property are you looking for?
   Waterfront Home WaterView Home Water Access Home Other Homes Waterfront Lot WaterView Lot Water Access Lot Other Lots Acreage Farmland Commercial

What price range are you interested in?
   $75,000 to $100,000 $100,000 to $150,000 $150,000 to $200,000 $200,000 to $300,000 $300,000 to $600,000 $600,000 to $900,000 $1,000,000 and over

When do you plan to be in our area?
  Within one week 1 month to 3 months 3 months to six months 6 months to 1 year other

Please tell us how to get in touch with you:

Name:
Address:
City:
State:
Zip Code:
E-mail:
Tel:
FAX:

Please enter any additional information that you feel
would assist us in finding the right property for you.