Contact Information:

Name: *This field is Mandatory.
Address:
City:
Province / State:
Postal / Zip Code:
Email: *This field is Mandatory.
Day Phone: *This field is Mandatory.
Eve Phone:
Fax:

Please describe the home you are interested in selling:

Where is the home located in Ottawa-Carleton?	Ottawa Nepean Barrhaven Kanata Gloucester Orleans Nepean Vanier Stittsville To be determined
How would you describe the neighbourhood?	Metropolitan Suburban Small Town Country
What style of property are you interested in selling?	Split level 2 Storey Multi-level Bungalow Apartment Other
What type of property are you interested in selling?	Single Family Townhouse Condominium Other
Please specify the number of Bedrooms	2 2 3+ 4 4+ 5+
Please specify the number of Bathrooms	1 1.5 2+ 2.5+ 3+
Please specify your expected price range	100,000 - 125,000 125,000 - 150,000 150,000 - 175,000 175,000 - 200,000 200,000 - 250,000 250,000 - 300,000 300,000 - 350,000 350,000 - 400,000 400,000 - 450,000 450,000 - 500,000 Over 500,000

If you have any other questions / comments / or other requests, please enter them in the space provided below.

Selling Particulars

Selling Timetable:	Please Select Immediately Less than 3 months 3 to 6 months 6 to 9 months 9 to 12 months Within the next year
Are you presently working with a Realtor®?	Yes	No

If you would like Linda to contact you, please specify when and how below.

Please specify how you would like to be contacted:	Via: Email Call Fax
I would prefer to be contacted on:	Weekdays	Weekends
Please specify the hours between which you would like to be contacted:	6:00 - 8:00 AM 8:00 - 10:00 AM 10:00 - 12:00 AM 12:00 - 2:00 PM 2:00 - 4:00 PM 4:00 - 6:00 PM 6:00 - 8:00 PM 8:00 - 10:00 PM	Mountain Central Eastern Other