INFORMATION REQUEST FORM
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:
When do you plan to build? 1 to 3 months 3 to 6 months 6 to 12 months
Type of house you are interested in:
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Price Range?
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?
Have you any additional questions or comments?