Name............

Street Address..

2nd Street......

City............

County..........

State...........

Zipcode.........

Home phone #....

Business phone#.

Fax #...........

email Address

Where do you plan to build?

We currently only service the North Western section of Pennsylvania

City,town, or area: 

County: 

When do you plan to build? ==Please Select==>1 to 3 months3 to 6 months6 to 12 months

Type of house you are interested in
(check one or more) ==(Please Select)==modularranchT ranchraised ranchcape codtwo storyColony SectionalsColony mobile homes

Price Range
(check one) $29,000 to $60,000 (mobile homes only) $75000 to $100000 $100000 to $190000

Do you own land? Yes No

Do you have a place to put your home? Yes No

Do you currently own your home? Yes No

Do you need a handicap accessible home? Yes No

Is your current home a Mobile or Double Wide? Yes No

Have you ever visited either of our sales lots? Yes No

How did you hear about us?
(check one) referral website link advertising factory referral other

Have you any additional questions or comments?