Berry Realty Company - Preferred Client Questionnaire

PREFERRED CLIENT QUESTIONNAIRE

Agent's Name:

General Information (all information provided will be kept confidential)

*First Name	*Last Name DOB
First Name(2)	Last Name(2) DOB

*Address
*City	State Zipcode

*Home Phone		Work Phone
Cell Phone 1		Cell Phone 2
Fax		Work Fax
Email 1		Email 2

Children's Names
Birthdays & Ages

Employer(s)

Referred By

If You Are Purchasing A Home

Desired Location(s)		Type of Home
Desired Price Range		Desired Down Pymt
Pre-qualified?	Yes No	Mortgage Co.
Do you own a home?	Yes No	If so, location
Is it on the market?	Yes No	Value of home
Currently working with another agent?	Yes No	If so, who?
Signed anything with another agent?	Yes No
Additional Comments

If You Are Selling A Home

Location		Type of Home
Currently working with another agent?	Yes No	If so, who?
Signed anything with another agent?	Yes No
Additional Comments


* Required Fields
*Click Here to Print a Blank Form.