Request for Relocation Information

David Blockhus
CRS, GRI, MBA

Email Dave

First Name:
Last Name:
Address:
Address 2:
City:
State/Province:
Zip Code:
Country:
Work Phone:
Home Phone:
Fax:

E-Mail Address (required):

enter "not available" if you don't have email

Desired commuting distance:

Desired areas (if known):

Children:

School Preferences
Public
Private
Parochial
Other

Ages:

Pets:

Floor Plan	New Construction 1 to 5 Years 5 to 10 Years	1 Story/Ranch 2 Story Tri & 4 Level
	Single Family Condo / Townhouse Other	Living Room Family Room Dining Room Fire Place
Number of Bedrooms	Two Three Four Five
Number of Bathrooms	One Two Three
Garage Size	1 Car 2 Car 3 Car
Price Range
Square Foot Desired

Are you planning a house hunting trip soon? Yes No
If so, when?

Do you have a home to sell? Yes No

If so, can I recommend a realtor in your area? Yes No

Additional Comments:

David Blockhus, CRS, GRI, MBA

CRS
110 First St., Los Altos, CA 94022
(650) 917-4250 - Phone
(650) 948-3749 - Fax

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